US20110160535A1 - Surgical access port with embedded imaging device - Google Patents

Abstract

Disclosed is a disposable access port for use in endoscopic procedures, including laparoscopic procedures. The access port includes a cannula with an embedded camera in communication with an external control box. In operation, a trocar is combined with the access port to facilitate insertion of the access port into an anatomical site. Prior to insertion, the camera is pushed inside the cannula, where it remains during insertion. The trocar is removed after the access port has been inserted to allow surgical instruments to access the anatomical site. During removal of the trocar, a portion of the trocar urges the camera out of the cannula, thereby allowing visualization of the anatomical site. The camera can be fixedly or adjustably mounted on the port. A camera may also be mounted on the trocar. The trocar may include irrigation and suction channels to facilitate a clear view of the anatomical site.

Description

CLAIM OF PRIORITY
• This application is a divisional of and claims the benefit of priority under 35 U.S.C. § 120 to U.S. patent application Ser. No. 11/834,540, filed on Aug. 6, 2007, which claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 60/835,543, filed Aug. 4, 2006, the benefit of priority of each of which is claimed hereby, and each of which is incorporated by reference herein in its entirety.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates generally to the field of endoscopic devices, and more particularly, to laparoscopic surgical devices including laparoscopic ports which provide minimally invasive access to the abdominal cavity.
• 2. Description of the State of the Art
• Endoscopic surgery has become the new standard for surgical procedures. A specific type of endoscopic surgery, laparoscopic surgery, has become the preferred method for surgeries involving the organs within an abdominal cavity or peritoneal cavity of a patient.
• Laparoscopic surgery employs small incisions appropriately placed on a patient's abdomen instead of one large incision as was the custom in traditional laparotomies or “open” surgeries. Instruments are inserted through these small incisions, and the surgery is performed via the manipulation of these instruments.
• Laparoscopic ports are employed to provide effective access to the abdominal cavity. Such ports maintain an air-proof seal and to facilitate the insertion of medical devices into the incisions. Multiple incisions and multiple laparoscopic ports allow the simultaneous use of different instruments including a laparoscope, which displays images on a video display in order to guide the surgeon. The port through which the laparoscope is inserted is commonly referred to as the primary port, while ports for the other instruments are referred to as ancillary ports.
• Many laparoscopic ports, also known as laparoscopic access systems, involve a cannula, which is a hollow tube, and a removable trocar, which is inserted through the cannula to facilitate insertion of the cannula through the abdominal wall. The distal tip of a trocar may be either sharp or blunt. The external opening of the cannula through which instruments are inserted is often referred to as the entry port of the cannula and the opening at the tip of the cannula through which the instrument emerges inside the peritoneal cavity is referred to as the exit port.
• One of the first steps during a laparoscopic surgical procedure involves insufflation of the abdomen with nitrogen or carbon dioxide gas. The resulting expansion of the abdomen reduces the risk of injury to the contents of the abdomen during subsequent insertion of the ports and also allows the surgeons more freedom and space to manipulate instruments and perform the surgery.
• Insertion of the primary port is accomplished either blindly or through the use of a device that allows some visualization through the laparoscope's camera as the tip of the trocar penetrates the abdominal wall. Insertion of the ancillary ports is generally accomplished while using a laparoscope at the primary port to observe the peritoneum at the ancillary point of insertion. Such observation reduces the risk of damaging abdominal organs beneath the point of insertion, such as may occur when the trocar is pushed too far into the abdominal cavity.
• Laparoscopic surgery is generally performed with only one source of visualization, namely, the camera at the tip of the laparoscope. However, in order to minimize risk of injury to the patient, it is preferable to observe the exit ports of all cannulas every time an instrument is inserted or withdrawn. Such observation currently requires that the camera on the tip of the laparoscope be directed toward a particular port. This would then result in the loss of visualization of the surgical field, which interrupts the surgical procedure and interrupts the use of the surgical instruments until the surgical field can again be visualized with the laparoscope.
• In addition, sometimes during the course of a surgery an endoscopist or surgeon determined that the view through the laparoscope is not optimal for safe manipulation of the instruments, and it is necessary to withdraw the laparoscope from the primary port and insert it through one of the ancillary ports in order to provide visualization of the surgical field from a more appropriate angle. This also interrupts the surgical procedure and increase risk to the patient.
• Therefore, it is desirable to have multiple concurrent views of the surgical field. With currently available technology, the only way to provide such visualization would be through the insertion of a second laparoscope. However, because laparoscopes are relatively long and heavy, a surgeon or an assistant must have one hand occupied with the laparoscope at all times unless it is attached to a robotic arm. Furthermore, laparoscopes require sterilization between uses, and using more than one laparoscope for a procedure would result in significant additional expense for sterilization. Additionally, because many laparoscopes have cameras with a nonadjustable viewing angle, multiple laparoscopes, each having a different viewing angle, are often required to be exchanged during a surgical procedure. Because laparoscopes are very expensive, using more than one laparoscope for a surgical procedure would require a hospital or surgical facility to make a substantial additional investment to have extra laparoscopes on hand, which also requires increases maintenance and sterilization expenses.
• Therefore, there exists a need for a more practical and less expensive method of providing multiple concurrent views of a surgical field. There is also a need for a more efficient method of viewing the insertion point of ancillary ports through the peritoneum and of viewing insertion and withdrawal of surgical instruments at the ancillary ports. Further, there exists a need to reduce manipulation and exchange of laparoscopes and other endoscopic instruments during minimally invasive procedures, which would reduce the time required to complete the procedure, limit the overall cost, and reduce patient risk. The present invention satisfies these and other needs.
SUMMARY OF THE INVENTION
• Briefly and in general terms, the present invention is directed to surgical endoscopic ports, including laparoscopic ports. An endoscopic port assembly comprises an endoscopic port including a lumen, a trocar sized to be insertable into the lumen, and an imaging device disposed on either one of the endoscopic port and the trocar.
• The port of endoscopic port assembly, in other aspects of the present invention, further includes a handle at a proximal end of the port and a cannula at a distal end of the port, the imaging device being disposed on the cannula. In other aspects, the imaging device is mounted on the cannula and is movable between a radially inward position and a radially outward position.
• In detailed aspects, the imaging device includes either one or both of an imaging sensor and a light source. In other aspects, the imaging device includes an imaging lens that is inside the cannula when the imaging device is in the inward position and is outside the cannula when the imaging device is in the outward position.
• The endoscopic port assembly, in other aspects of the present invention, further comprises a detent mechanism that holds the imaging device in the outward position until the imaging device is pushed toward the inward position. In other aspects, the assembly further comprises a movable control member that is connected to the imaging device such that manipulation of the control member moves the imaging device.
• In detailed aspects, a portion of the lumen is defined by a tubular wall to which the imaging device is movably mounted. The trocar includes a shaft. There is a gap between the shaft and the tubular wall when the trocar is inserted into the lumen. The gap sized to receive at least a portion of the imaging device.
• The trocar, in other aspects of the invention, includes a distal tip region connected to the shaft, the distal tip region being wider than the shaft such that, when the trocar is removed from the port, the distal tip region pushes the portion of the imaging device disposed within the gap such that the imaging device moves in a radially outward direction from the tubular wall.
• In yet other aspects of the invention, the imaging device is attached to the trocar such that the imaging device extends beyond the distal end of the port when the trocar is inserted into the lumen.
• The endoscopic port assembly, in further aspects of the invention, comprises a controller in communication with the imaging device, the controller providing power and control commands to the imaging device, the controller receiving image signals from the imaging device. In other aspects, the controller and the imaging device each include a wireless transceiver.
• In other aspects of the invention, a laparoscopic device comprises a laparoscopic port including an imaging device. In detailed aspects, the port includes a handle and a cannula connected to the handle, the handle having an instrument entry opening in communication with an instrument with an instrument exit opening at a distal tip of the cannula. In other detailed aspects, the imaging device includes an imaging lens and is mounted to the cannula such that the lens is movable between a position outside the cannula and a position inside the cannula. In other aspects, the imaging device includes an imaging lens disposed at a distal edge of the cannula.
• The cannula of the laparoscopic device, in other aspects of the invention, defines at least a portion of an instrument passageway extending from the instrument entry port to the instrument exit port. In other aspects, the cannula includes a lumen housing the imaging device. In yet other aspects, the cannula includes a lumen capable of provide irrigation, suction, or both.
• In other aspects of the invention, an endoscopic port assembly comprises an endoscopic port including a proximal end, a distal end, an instrument passageway extending from the proximal and distal ends, and a first seal disposed within the passageway, the first seal movable between an open position at which air may flow through the passageway and a closed position at which air flow through the passageway from the distal end to the proximal end is blocked. The assembly also comprises an imaging device disposed on the port.
• In detailed aspects, the first seal is adapted to move to the open position when an instrument is inserted into the passageway and to move to the closed position when the instrument is removed from the passageway.
• The port of the endoscopic port assembly, in further aspects of the invention, further includes a second seal adapted to block air flow through the passageway when an instrument is inserted into the passageway. In other aspects, a portion of the passageway is defined by a tubular wall to which the imaging device is mounted. In yet other aspects, the imaging device includes a lens and is movably mounted to allow the lens to be adjustably oriented at an angle between about zero degrees and about ninety degrees from a central axis of the tubular wall. In further aspects, the imaging device includes a lens located at a distal edge of the tubular wall.
• In other aspects of the present invention, a method of deploying an endoscopic viewing device comprises inserting a trocar into an endoscopic port that includes an imaging device oriented in an outward position. The method also comprises pushing the imaging device from the outward position to an inward position after the trocar is inserted in the port. The method further comprises removing the trocar from the port such that the imaging device is urged from the inward position to the outward position.
• In further aspects of the invention, the method comprises pushing the imaging device from the outward position to the inward position after the trocar is removed from the port, the imaging device is being pushed by an abdominal wall.
• In detailed aspects, when the imaging device is in the outward position, the imaging device protrudes outwardly from an exterior surface of the port. In other detailed aspects, when the imaging device is in the inward position, the imaging device does not protrude outwardly from an exterior surface of the port or protrudes less than when the imaging device is in the outward position.
• The features and advantages of the invention will be more readily understood from the following detailed description which should be read in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a surgical access port assembly showing an access port including a cannula, a camera embedded in the cannula, and a trocar inserted into the cannula such that the a trocar tip extends beyond a cannula tip.
• FIG. 2 is a perspective view of a control box in communication with the camera.
• FIG. 3 is a front perspective view of the cannula showing an elongate sleeve connected to a cannula handle and an instrument exit opening formed in the sleeve.
• FIG. 4 is a rear perspective view of the cannula showing an instrument entry opening formed in the cannula handle and a concentric seal adjacent the entry opening.
• FIG. 5 is a cross-sectional view of the cannula showing an instrument passageway extending from the instrument exit opening, and another seal disposed within the instrument passageway between the concentric seal and the instrument exit opening.
• FIG. 6 is a perspective view of the trocar showing a trocar shaft connected to a trocar handle, the trocar shaft having a medial segment and distal segment wider than the medial segment.
• FIG. 7 is a close-up perspective view of the trocar shaft showing a sharp point on the distal segment.
• FIG. 8 is a close-up view side view of a distal region of the access port showing a gap between the medial portion of the trocar and an inner surface of the trocar sleeve, the gap sized to receive the embedded camera which is movable between a radially inward position and a radially outward position.
• FIG. 9 is an exploded view of a camera capsule showing light sources, the camera, and associated electronics housed within an upper housing and a bottom housing with a distally facing sloped surface that allows the trocar to push the camera to the radially outward position when the trocar is withdrawn from the cannula.
• FIG. 10 is a perspective view of the cannula showing an electrical wire conduit inside the cannula, the conduit extending between the camera capsule and a connector on the cannula handle.
• FIG. 11 is a block diagram of circuitry of the camera capsule.
• FIG. 12 is a block diagram of circuitry of the control box.
• FIG. 13 is a perspective view of a display monitor in communication with the control box showing a main screen picture capable of showing a main view from a camera on a main access port and smaller pictures within the main screen picture capable of showing ancillary views from cameras on ancillary access ports.
• FIG. 14 is a perspective view of a trocar having three projection features at a distal tip of the trocar for facilitating entry of the trocar into an anatomical site.
• FIG. 15 is a close-up side view of a distal region of an access port assembly showing a blunt tip trocar inserted through an instrument passageway of an access port sleeve, and showing an integrated camera on the access port sleeve disposed outside an outer surface of the sleeve due to contact with a distal portion of the blunt tip trocar, the distal portion having a larger diameter than the medial portion of the trocar ofFIG. 8.
• FIG. 16 is a perspective view of an access port showing a cannula sleeve, two cameras integrally mounted on the cannula sleeve, a cannula handle, and two controls on the handle adapted to allow for independent adjustment of camera viewing directions from between about zero degrees and about ninety degrees from a central axis of the cannula sleeve.
• FIG. 17 is a perspective close-up view of an access port cannula showing an instrument exit opening at a distal end of the cannula, an instrument lumen extending from the exit opening, an imaging device disposed on a distal edge adjacent the exit opening, and an additional lumen housing the imaging device and imaging communication lines.
• FIG. 18 is a perspective close-up view of an access port cannula showing an access port sleeve, an exterior channel disposed on an exterior surface of the sleeve, and an imaging device including two light sources and a camera disposed on a distal end of the exterior channel, the exterior channel housing imaging communication lines for the imaging device.
• FIG. 19 is a perspective close-up view of an endoscopic device showing a handle connected by a shaft to a distal tip adapted to puncture an anatomical region and gain access to a surgical site, and an imaging device adjacent the distal tip.
DETAILED DESCRIPTION OF THE INVENTION
• The term “endoscopic surgery” is a broad term that includes many varieties of surgeries such as laparoscopy. The scope of the present invention includes various types of endoscopic procedures, including laparoscopic surgery and other minimally invasive forms of surgery. The present invention also applies to any type of surgery that makes use of a trocar or cannula or similar devices.
• In an embodiment of the present invention, a trocar is inserted into a cannula until it snaps into place as the projections on the trocar handle engage with complementary grooves on the corresponding sections of the cannula handle. An integrated imaging device, such as a camera, forms part of the cannula, trocar, or both. Corresponding electrical cabling for the camera is connected to connectors on an external control box and the cannula handle. The camera is powered on through the control box, and the control box begins to process the images captured by the camera and displays them on a monitor.
• The camera is housed in a camera capsule. In some embodiments, the camera capsule forms part of the cannula and is initially located outside the main lumen of the cannula adjacent to the shaft of the trocar. In use, the camera capsule is tucked by hand into the main lumen prior to inserting the trocar and cannula through the abdominal wall or other anatomical site. Once the trocar and cannula have been inserted into the anatomical site, the trocar is withdrawn from the cannula, which in turn causes the camera capsule to be swiveled into its outside lumen position. Other instruments can now be inserted through the lumen of the cannula as images are collected by the integrated camera. Other instruments include those used for cutting, ablation, suction, irrigation, grasping, retracting, and suturing.
• After the surgery is completed, the cannula is simply withdrawn from anatomical site, causing the camera capsule to be automatically swiveled into its inside lumen position due to pressure and friction from tissue surrounding the cannula. The cannula is disconnected from the electrical cabling and the control box and is disposed along with the trocar.
• Referring now in more detail to the exemplary drawings for purposes of illustrating embodiments of the invention, wherein like reference numerals designate corresponding or like elements among the several views, there is shown inFIG. 1 alaparoscopic port10 comprising two main mechanical units: acannula12 and atrocar14. Thelaparoscopic port10 is optionally connected by means of acable80 to acontrol box74 shown inFIG. 2. Although the assembly illustrated inFIG. 1 is described as a laparoscopic port, it will be appreciated that the illustrated assembly may also be used for providing surgical access to various anatomical cavities and regions in addition to the abdominal cavity of a patient.
• FIG. 3 shows thecannula12 separated from thetrocar14. Thecannula12 includes an integrated, embeddedcamera16 capable of providing a view of the portion of the peritoneal cavity that lies distal to the exit port of the cannula. Thecannula12 includes asingle lumen17, or interior passageway, that provides access to the abdominal cavity for the insertion of surgical instruments. A portion of thelumen17 is defined by an tubular member orelongate sleeve18 which contains thecamera16. Thesleeve18 extends from acannula handle20 on aproximal end22 of thecannula12. At the distal end of thesleeve18, there is anexit port23 in the form of a circular opening through which surgical instruments enter the abdominal cavity of a patient.
• Thecannula12 can be constructed from multiple parts of plastic, such as polyethylene, which are fastened together by a method, such as snap-fit, welding, or adhesive bonding, that ensures an air-tight seal to separate compartments within the cannula from the outside environment.
• Referring now toFIG. 4, the cannula handle20 includes anentry port24 in the form of a circular opening that provides proximal access to the lumen of the cannula. In order to maintain insufflation pressure within the abdominal cavity, aconcentric seal26 adjacent theentry port24 is configured to prevent leakage of gas when an instrument is present within thecannula12. Theconcentric seal26 can be made from a flexible material such as rubber.
• As shown inFIG. 5, in the cannula handle20 there is aninterior seal28 in the form of a hatch that provides instrument access to anairtight compartment30 and thesleeve18. A hingeddoor32 includes alip34. Thedoor32 is shown in an open position (illustrated in solid lines) and in a closed position (illustrated in broken lines). When in the closed position, thedoor32 andlip34 ensures an air tight seal. Theinterior seal28 maintains insufflation pressure within the abdominal cavity when an instrument is not present in the cannula. The hingeddoor32 is designed to open toward the distal end of the cannula when an instrument is inserted into thecannula12 from theentry port24 at theproximal end22. The hingeddoor32 can be constructed from plastic, while thelip34 can be formed from a deformable material such as rubber.
• Still referring toFIG. 5, on one side of the cannula handle20 there is aninsufflation air port36. During a laparoscopic procedure, theair port36 allows nitrogen, carbon dioxide, or other gas to be introduced into a patient's abdominal cavity to achieve and maintain a desired insufflation pressure. Alever38 controls whether a valve inside theair port36 is open or closed.
• FIG. 6 shows thetrocar14 separated from thecannula12. Thetrocar14 can be constructed from components made from a plastic such as polyurethane, which are joined together by a method such as snap-fit. Components of thetrocar14 can also be constructed of a metal. Thetrocar14 includes atrocar handle40 at itsproximal end44. A narrow cylindrical member orshaft46 extends from the trocar handle40 to adistal end48 of thetrocar14. Theshaft46 has agreater diameter47 along ashort distance49 at thedistal end48. At the very tip of theshaft46, there may be asharp point50 to facilitate insertion of the trocar and cannula through the abdominal wall or other anatomical region.
• As illustrated inFIGS. 6 and 7, thepoint50 at thevery tip48 of thetrocar shaft46 may be shaped like a triangle.
• Referring again toFIG. 6, the trocar handle40 includes two projection features52, one on each side. The projection features52 mate with complimentary grooves54 (FIG. 5) on the corresponding sections of acannula handle20. Eachprojection feature52 is attached to adepressible button56 which facilitates release of the trocar handle40 from thecannula handle20.
• As shown inFIG. 8, thecamera16 and one or more light sources are integrated into an adjustable imaging device orcamera capsule58 located at a distal portion of acannula12. Thecamera capsule58 is shown in a position outside the cannula lumen17 (illustrated with solid lines) and in a position inside the cannula lumen17 (illustrated with broken lines). Atrocar14 is shown inserted into thecannula12.
• As shown inFIG. 9, thecamera capsule58 includes thecamera16 and associatedelectronics61. The capsule is created from twocomplementary housing components62,64 which can be constructed from a plastic such as polyethylene. Thebottom housing64 exhibits a decline shape or distally facing slopedsurface66, which allows the retraction of a trocar from a cannula to push thecamera capsule58 from a position inside the cannula lumen to a position outside the cannula lumen. A single printed circuit board (PCB)67 inside thecapsule58 includes the necessary electronics for the imaging device. Acamera lens68 andimage sensor70 are integrated into thetop housing62 of thecapsule58. Thelens68 is mounted such that it overlies theimage sensor70 and focuses light entering the lens onto a photosensitive area of the image sensor. An integrated lens can be made by bonding the lens assembly onto the image sensor chip by means of optically inert glues such as Canada balsam.
• Still referring toFIG. 9, in order to provide a light inside an abdominal cavity or other anatomical cavity of a patient,light sources60, such as light emitting diodes (LEDs), are also integrated into thetop component62 of thecapsule58. Thecapsule58 includes ahinge mechanism72 to attach thecapsule58 to the distal portion of thecannula12. Thishinge mechanism72 also allows thecamera capsule58 to exhibit movement in a single plane as illustrated inFIG. 8. Thisswivel mechanism72 allows the camera capsule to be tucked inside thelumen17 of thecannula12 or to lie just outside of the lumen while thetrocar14 andcannula12 are being inserted into an anatomical site.
• Preferably, but not necessarily, other electrical components are found in thecamera capsule58 and the control box74 (FIG. 2).
• As shown inFIG. 10, electrical wiring from thecamera capsule58 is carried to the proximal end of the cannula through aconduit76 and is interfaced to aconnector78 at thecannula handle20. A cable assembly80 (FIG. 2) routes these electrical connections to the control box74 (FIG. 2) through one of theconnectors82 provided on the control box. The electrical wiring includes power, data/signal, and control lines. Power and control commands are received through the respective wires from thecontrol box74, and the datal/signal line carries the video images to the control box.
• Referring again to9, the PCB57 within thecamera capsule58 includes a power management integrated circuit (IC)130, a clock orcrystal132, and asignal processing IC134.
• InFIG. 11, there is shown a block diagram of circuitry within thecamera capsule58. Electrical wires84 (FIG. 9) connect the PCB57 to theimage sensor70 andLEDs60, which are integrated into thecapsule58. Power to thelight sources60 is routed via thepower management circuit130 on the camera capsule PCB57. Controlling circuitry may be included in this PCB57 for adjusting the intensity of the light. This can be achieved by using a device such as a LED driver which can be controlled via the same or separate control line depending on the control technique employed.
• Theimage sensor70 integrated into thetop housing62 of thecapsule58, as shown inFIG. 9, is an electronic device which converts light incident on photosensitive semiconductor elements into electrical signals. The signals from thesensor70 are digitized and used to reproduce the image that was incident on the sensor. Two types ofimage sensors70 are Charge Coupled Devices (CCD) and Complementary Metal Oxide Semiconductor (CMOS) camera chips.
• The image data captured by theimage sensor70 is then decoded by the signal processing integrated circuit86 (FIG. 9). The variety of image sensor output formats and video signal processing integrated circuits is well documented and understood in the consumer electronics industry, and so this process is not explained in further detail. Once the signal has been converted to a suitable format, it is transferred to the control box74 (FIG. 2).
• Referring again toFIG. 2, thecontrol box74 transmits power and control commands from its internal circuitry to thecamera capsule58 near the distal end of thecannula12. Thecontrol box74 also serves to process and retransmit the video streams received from thecamera capsule58 to a display device, such as anLCD display88 on thecontrol box74 or a video monitor connected tovideo output connectors90 on the control box.
• Thecontrol box74 comprises of image and signal processing circuitry in an enclosure with a control panel,LCD display88, and connectors. TheLCD display88 in conjunction with the control panel provides a menu-driven interface.FIG. 2 shows the physical layout of thecontrol box74, whileFIG. 12 shows a block diagram of the circuitry of the control box. It will be appreciated that thecontrol box74 can be configured in ways other than what is shown inFIG. 2.
• As shown inFIG. 12, thecontrol box74 comprises image andsignal processing Ics136, a crystal orclock138, input andoutput interfaces140, apower management IC142, button input switches144, and a controller CPU146. After thecontrol box74 receives the signal from thecamera16, the controller CPU146, which includes a signal processing IC, decodes the signal and is sent toimage processing circuits136. These circuits process the video signal in order to enhance image quality, extract still images, and convert the video format to other output formats. Once the video images have been processed, they are sent back to the controller CPU146 for output to an external monitor.
• Still referring toFIG. 12, the controller CPU146 also interfaces with theimage sensor70 of thecamera capsule58. This CPU allows users to employ thebuttons92, knobs94, and a menu-driven interface of the control box74 (FIG. 2) to control mode settings, brightness, and exposure time by writing digital commands to specific registers controlling each of these parameters on the image sensor of the camera. These registers can be addressed by their unique addresses, and digital commands can be read from and written to these registers to change the different parameters.
• Thecontrol box74 has the capability to connect with multiple laparoscopy port camera systems simultaneously. The video signals from these multiple cameras can then be displayed on multiple displays or on asingle display monitor96 using a split-screen or picture-in-picture (PIP), as shown inFIG. 13. A view of the main endoscope can be shown on themain portion98 of thedisplay monitor96, while additional views from various camera capsules can be shown assmaller pictures100 within the main portion of the display.
• Operation of the system shown inFIGS. 1-13 will now be described in accordance with an embodiment of the present invention. Theelectrical cable80 between thecannula handle20 andcontrol box74 is connected to theappropriate connectors78,82. Thecamera capsule58 in the distal portion of thecannula12 is pivoted outward by hand to the outside of the cannula lumen. Thetrocar14 is then slid into thecannula12 until the trocar handle40 snaps into thecannula handle20.
• Thecamera16 is then powered on by manipulating controls found on thecontrol box74. Thecamera16 begins to transmit video images to thecontrol box74 through the electrical wires in thecannula12. The internal circuitry of thecontrol box74 decodes and processes the signal in order to create video signals for output to anexternal monitor96. The images are then displayed on theexternal monitor96.
• Before inserting thecannula12 andtrocar14 into a patient, thecamera capsule58 is pivoted inward by hand into thelumen17 of thecannula12 in order to facilitate insertion. Thecannula12 andtrocar14 are pushed through the abdominal wall or other anatomical region by taking advantage of the cuttingsurface50 on the distal tip of the trocar.
• Once the anatomical region has been entered, thetrocar14 is withdrawn, leaving thecannula12 in place. Thelarger diameter47 of the distal tip of thetrocar14 causes thecamera capsule58 to pivot outward to its outside the lumen position. Under direct visualization through itscamera16, thecannula12 is then carefully advanced to the appropriate depth. Thecannula12 is then ready to accept instruments through thecannula lumen17.
• Additional cannulas or access ports having cameras can be employed and connected to thesame control box74. Through the use of buttons on thecontrol box74, the user can vary brightness and other settings. The user can also obtain still images by pressing various buttons on thecontrol box74. After the surgery is completed, the access ports are simply withdrawn and associated cable connections are disconnected. As the access ports are withdrawn, pressure and frictional forces acting on the sides cause the camera capsules to pivot back to their inside the lumen position. The access ports are then discarded along with the trocars.
• In some embodiments of the present invention, a trocar has a blunt tip, instead of a sharp tip, to minimize the risk of injuring organs beneath the insertion point. In other embodiments, atrocar14 has adistal tip48 with threeprojections102 made from plastic or metal, as shown inFIG. 14. Theprojections102 are spaced equally around a center point on thedistal tip48 of thetrocar14.
• In other embodiments of the present invention, a camera capsule is integrated at a point on the cannula that is more proximal or distal than is shown inFIGS. 1,3,4,8, and10. The hinge connector, which attaches the capsule to the cannula, can also be varied in order to provide a range of pivot angles.
• InFIG. 15 there is shown an embodiment in accordance with the present invention in which ablunt tip trocar14 is used to keep acamera capsule58 in its “outside lumen position” even when there is no surgical instrument inserted through theaccess port sleeve18. Instead of thenarrow shaft46 ofFIG. 8, which allows thecamera capsule58 to lie in its “inside lumen position” during insertion of thecannula12 andtrocar14 through an abdominal wall, theshaft46 ofFIG. 15 has anoutside diameter104 that is only slightly smaller than theinside diameter106 of theaccess port sleeve18. Therefore, the trocar ofFIG. 15 exerts pressure on thebottom housing64 of thecamera capsule58, thus maintaining the camera capsule in its “outside lumen position” so that the camera capsule can provide visualization of the surgical site for the duration of the procedure, even when there is no surgical instrument inserted through that port. Theshaft46 could have thislarger diameter104 throughout its full length, or only in that portion of the shaft where it would be required in order to exert pressure on thecamera capsule58 to maintain the camera capsule in its outside lumen position. The handle of the blunt tip trocar ofFIG. 15 can be similar to that of the trocar used to facilitate insertion of the cannula, including projection features that mate with complimentary grooves found on the corresponding sections of the handle of the cannula.
• In other embodiments of the present invention, a camera capsule is connected to a detent mechanism that, once the camera capsule has been swiveled into its outside lumen position through pressure from the tip of the trocar during withdrawal of the trocar, maintains the camera capsule in its outside lumen position for the duration of the surgical procedure, whether or not there is a trocar or other instrument occupying the lumen of the cannula. When the cannula is withdrawn, pressure and friction from the surrounding tissue of the abdominal wall will force the camera capsule to swivel past the detent mechanism and into its inside lumen position, thus facilitating withdrawal of the cannula while preventing trauma to the surrounding tissue.
• In another embodiment, the cannula includes a mechanical control preferably near the cannula handle which allows the user to adjust the pivot angle of the camera from outside the patient's body. Two pull wires are attached to the camera capsule, and a lever attached to these wires is manipulated in order to articulate the camera capsule.
• InFIG. 16, there is shown an embodiment of the present invention in which anaccess port12 employsmultiple camera capsules58 withimaging lenses68 that are oriented such that they can provide additional viewpoints. For example, oneimaging lens68A can be oriented longitudinally whileother lens68B can be oriented at a right angle to thelongitudinal axis108 ofaccess port12. This right angle view would provide an image that is especially useful for observing the exit ports of the other access ports during insertion and withdrawal of surgical instruments without requiring excessive manipulation of theaccess port12. The twocamera capsules58 can be pivoted independently of one another to adjust its angle of view through an externally-controlledmechanism110 without requiring movement of theentire access port12.
• Referring now toFIG. 17, acamera capsule58, which includes acamera16 andlight sources60, is integrated into acannula sleeve18 having a smalladditional lumen112 that houses the camera capsule and associated wires. Thecamera16 and thelight sources60 are located on adistal edge116 surrounding anexit port23 of acannula12. The cylindrical component of thecannula12 that houses themain instrument lumen17 and theadditional lumen112 could be created by extruding a material such as polyethylene. In this embodiment, thecamera16 would be fixed in position, while themain lumen17 would allow the passage of surgical instruments. Furthermore, this embodiment would allow visualization during insertion of thecannula12 and trocar in order to prevent any accidental damage to tissue or organs.
• FIG. 18 depicts an embodiment in which anon-adjustable camera capsule58 lies, along with its electrical wires, in a lumen ortube114 that is external to thesheath18 of acannula12. Thecamera capsule58, which includes acamera16 and twolight sources60, is adjacent adistal edge116 surrounding anexit port23 of thecannula12. Thetube114 can be bonded to the outside surface of thecannula sheath18 or simultaneously created with thesheath18 by extruding a material such as polyethylene.
• In another embodiment, an access port would employ an imaging lens located near the distal tip of the cannula. Fiber optic bundles embedded in the sheath of the cannula are employed to transfer images to an imaging sensor that may be located in the handle of the cannula. The imaging sensor receives the light signals and digitizes them for transfer to a video processing system and for display on a monitor or other output.
• In yet another embodiment, an access port would not utilize embedded LEDs as a light source, but would instead employ one or more fiber optic bundles embedded in the sheath of the cannula to transfer light from an external source to the tip of the cannula to provide illumination of the surgical field.
• FIG. 19 depicts an embodiment of the present invention in which atrocar14, which is adapted to pass through a cannula, contains alight source60, such as one or more LEDs or fiber optic bundles, as well as asensor70 with associated electrical wiring to transmit an image to a video processing system. Thetrocar14 ofFIG. 19 can extend a variable distance beyond the distal tip of the cannula in order to provide additional visualization of the surgical field, including close-up views.
• In a further embodiments, a trocar can employ multiple camera capsules each having lenses and sensors that are oriented such that they can provide additional viewpoints. For example, one lens and sensor can be oriented longitudinally while another lens and sensor can be oriented at a right angle to a longitudinal axis of the trocar. This right angle view would provide an image that is especially useful for observing the exit ports of the other access ports during insertion and withdrawal of surgical instruments without requiring excessive manipulation of the trocar. The camera capsules can be pivoted to adjust their angle of view through an externally-controlled mechanism without movement of the trocar and its other camera capsules.
• In other embodiments, imaging systems within a trocar employ imaging lenses located near the trocar distal tip. Fiber optic bundles embedded within the trocar transfer images from the imaging lenses to sensors located in the handle of the trocar. The sensor receive the light signals and digitize them for transfer to a video processing system and for display on a monitor or other output.
• In further embodiments, a trocar includes an imaging device and one or more channels that can be used for water or saline irrigation, suctioning, or both, in order to further improve visualization of the surgical site.
• In some embodiments, a cannula does not include electrical/communication wires connected to a camera capsule on the cannula. The camera capsule transmits data directly to an external control box by using a wireless protocol such as Bluetooth. A small battery is included in the camera capsule in order to power the electrical components. A wireless transceiver, which is responsible for transmitting the data at a given frequency, is found both in the camera capsule PCB and circuitry of the external control box.
• In another embodiment, an external control box includes PC connectivity. Video and still images can be stored onto internal memory. These images can then be transferred to external removable flash memory or transferred directly to a PC via serial communication protocols such as Universal Serial Bus (USB). The storage of images in memory and serial communication protocols such as USB are well documented and understood in the consumer electronics industry and so they will not be explained in further detail. Such an embodiment facilitates the inclusion of these video or still images in a patient's electronic medical record (EMR) by transferring the images to a personal computer. In addition, the image processing capabilities of the control box can convert the image and video data to a compatible format such as jpeg, mpeg, or others for filing in the patient's EMR. Furthermore, data can be retained in the control box for a duration of time by assigning a unique identifier to the corresponding images of each surgical procedure.
• In some embodiments of the present invention, a cannula is be used independently of a trocar. A separate trocar or other puncturing or cutting device is utilized to make the incision. The cannula along with an integrated camera is then inserted into the incision. A camera capsule containing a camera can be articulated outward by inserting an instrument in the cannula lumen. Alternatively, a mechanical control with pull wires attached to the camera capsule can be employed to articulate the camera capsule.
• Referring again toFIGS. 1 and 3, anendoscopic port assembly10 is shown in accordance with an embodiment of the present invention. Theendoscopic port assembly10 can be used in a variety of endoscopic procedures. Theendoscopic port assembly10 comprises anendoscopic port12, atrocar14, and animaging device16. Theport12 includes alumen17. Thetrocar14 is sized to be insertable into thelumen17. Theimaging device16 is disposed on theport12. Theimaging device16 may optionally be disposed on thetrocar14.
• Referring next toFIG. 8, theport12 of theendoscopic port assembly10 may include a cannula ortubular member18 to which theimaging device16,58 is mounted in a manner such that the imaging device is movable between a radially inward position (illustrated with broken lines) and a radially outward position (illustrated with in solid lines). Radially inward refers to a direction toward a longitudinal,central axis118 of thetubular member18, such as shown bydirectional arrow120. Radially outward refers to a direction away from thecentral axis118, such as shown bydirectional arrow122.
• Referring again toFIGS. 3-4, a laparoscopic device is shown in accordance with an embodiment of the present invention. The laparoscopic device is useful for providing minimally invasive access to organs within the peritoneal cavity of a patient. The laparoscopic device comprises alaparoscopic port12 that includes anintegrated imaging device16. Theport12 preferably includes a cannula ortubular sheath18 to which theimaging device16 is mounted. Theimaging device16 is mounted such that an imaging lens of the imaging device is movable between a position outside thecannula18 and a position inside the cannula. Optionally, theimaging device16 is mounted such that the imaging lens is disposed at adistal edge116 of thecannula18.
• Referring once again toFIGS. 5 and 8, anendoscopic port assembly12 is shown in accordance with an embodiment of the present invention. Theassembly12 comprises anendoscopic port12 and animaging device58. Theport12 includes aproximal end22 and a distal end. Aninstrument passageway17 extends from the proximal and distal ends. Afirst seal28 is movable between an open position (illustrated with in solid lines) at which air may flow through the passageway and a closed position (illustrated with broken lines) at which air flow through the passageway from the distal end to the proximal end is blocked. Thefirst seal28 is adapted to move to the open position when aninstrument14 is inserted into thepassageway17. Thefirst seal28 is further adapted to move to the closed position when theinstrument14 is subsequently removed from thepassageway17. Theport12 also includes asecond seal26 that is adapted to block air flow through thepassageway17 when theinstrument14 is inserted into the passageway.
• While several particular forms of the invention have been illustrated and described, it will also be apparent that various modifications can be made without departing from the scope of the invention. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the invention. Accordingly, it is not intended that the invention be limited, except as by the appended claims.

Claims (23)

1. A method of deploying an endoscopic viewing device, the method comprising:

inserting a trocar into an endoscopic port including an imaging device oriented in an outward position;

pushing the imaging device from the outward position to an inward position after the trocar is inserted in the port; and

removing the trocar from the port such that the imaging device is urged from the inward position to the outward position.

2. The method ofclaim 1, comprising pushing the imaging device from the outward position to the inward position after the trocar is removed from the port, the imaging device being pushed by an abdominal wall.

3. The method ofclaim 1, wherein, with the imaging device is in the outward position, the imaging device protrudes outwardly from an exterior surface of the port.

4. The method ofclaim 1, wherein, with the imaging device is in the inward position, the imaging device does not protrude outwardly from an exterior surface of the port or protrudes less than when the imaging device is in the outward position.

5. The method ofclaim 1, wherein removing the trocar from the port includes a distal tip region of the trocar pushing a portion of the imaging device to move the imaging device radially outward to the outward position, wherein the distal tip region of the trocar is connected to a shaft, the distal tip region being wider than the shaft.

6. The method ofclaim 5, wherein removing the trocar from the port includes removing the trocar from within a lumen of a cannula of the port, the imaging device being disposed on the cannula.

7. The method ofclaim 1, comprising imaging an area using the imaging device.

8. The method ofclaim 1, comprising illuminating an area using a light source of the imaging device.

9. The method ofclaim 8, comprising imaging the area using the imaging device.

10. The method ofclaim 1, comprising holding the imaging device in the outward position using a detent mechanism, the imaging device staying in the outward position until the imaging device is pushed toward the inward position.

11. The method ofclaim 1, comprising:

sending an image signal from the imaging device; and

receiving the image signal using a controller in communication with the imaging device, wherein the controller provides power and control commands to the imaging device.

12. A method of using a laparoscopic device, the method comprising:

inserting a trocar into a laparoscopic port including an imaging device oriented in an outward position;

pushing the imaging device from the outward position to an inward position after the trocar is inserted in the port; and

removing the trocar from the port such that the imaging device is urged from the inward position to the outward position, wherein a distal tip region of the trocar pushes a portion of the imaging device to move the imaging device radially outward to the outward position, wherein the distal tip region of the trocar is connected to a shaft, the distal tip region being wider than the shaft.

13. The method ofclaim 12, wherein, with the imaging device is in the outward position, the imaging device protrudes outwardly from an exterior surface of the port.

14. The method ofclaim 12, wherein, with the imaging device is in the inward position, the imaging device does not protrude outwardly from an exterior surface of the port or protrudes less than when the imaging device is in the outward position.

15. The method ofclaim 12, wherein removing the trocar from the port includes removing the trocar from within a lumen of a cannula of the port, the imaging device being disposed on the cannula.

16. The method ofclaim 12, comprising providing at least one of irrigation or suction through the lumen.

17. The method ofclaim 12, comprising imaging an area using the imaging device.

18. The method ofclaim 12, comprising illuminating an area using a light source of the imaging device.

19. A method of using an endoscopic port assembly, the method comprising:

inserting a trocar into an endoscopic port including a proximal end, a distal end, an instrument passageway extending between the proximal and distal ends, and a first seal disposed within the passageway, a portion of the instrument passageway including a tubular wall, the first seal movable between an open position at which air may flow through the passageway and a closed position at which air flow through the passageway from the distal end to the proximal end is blocked, wherein an imaging device is mounted to the tubular wall, the imaging device being oriented in an outward position;

pushing the imaging device from the outward position to an inward position after the trocar is inserted in the port; and

removing the trocar from the port such that the imaging device is urged from the inward position to the outward position, wherein a distal tip region of the trocar pushes a portion of the imaging device to move the imaging device radially outward from the tubular wall to the outward position, wherein the distal tip region of the trocar is connected to a shaft, the distal tip region being wider than the shaft.

20. The method ofclaim 19, comprising:

moving the first seal to the open position with insertion of an instrument into the passageway; and

moving the first seal to the closed position with removal of the instrument from the passageway.

21. The method ofclaim 20, comprising blocking, using a second seal, air flow through the passageway with insertion of an instrument into the passageway.

22. The method ofclaim 20, comprising imaging an area using the imaging device.

23. The method ofclaim 22, wherein imaging the area includes moving a lens of the imaging device, the lens being adjustably oriented at an angle between about zero degrees and about ninety degrees from a central axis of the tubular wall.

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