U.S. patent application number 12/789643 was filed with the patent office on 2010-09-16 for surgical instruments with improved dexterity for use in minimally invasive surgical procedures.
This patent application is currently assigned to SurgiQuest, Inc.. Invention is credited to Kurt Azarbarzin, Dominick Mastri, Ralph Stearns.
Application Number | 20100234687 12/789643 |
Document ID | / |
Family ID | 40718469 |
Filed Date | 2010-09-16 |
United States Patent
Application |
20100234687 |
Kind Code |
A1 |
Azarbarzin; Kurt ; et
al. |
September 16, 2010 |
SURGICAL INSTRUMENTS WITH IMPROVED DEXTERITY FOR USE IN MINIMALLY
INVASIVE SURGICAL PROCEDURES
Abstract
A surgical instrument adapted and configured for use in
minimally invasive surgical procedures includes a shaft, an end
effector and a proximal handle. The longitudinal shaft has proximal
and distal end portions, and defines a longitudinal axis of the
surgical instrument. The distal end effector is connected to the
distal end portion of the shaft, and is adapted and configured for
performing a surgical task. The proximal handle portion is operably
connected to the proximal end portion of the longitudinal shaft and
has an actuatable portion operably connected to the end effector to
result in movement of the end effector. The distal end portion of
the shaft can be laterally offset from the longitudinal axis of the
shaft and/or have one or more bends or curves formed therein. The
proximal portion of the shaft can include at least one bend to
allow for comfortable positioning of a surgeon's hands.
Inventors: |
Azarbarzin; Kurt;
(Fairfield, CT) ; Mastri; Dominick; (Bridgeport,
CT) ; Stearns; Ralph; (Bozrah, CT) |
Correspondence
Address: |
EDWARDS ANGELL PALMER & DODGE LLP
P.O. BOX 55874
BOSTON
MA
02205
US
|
Assignee: |
SurgiQuest, Inc.
Orange
CT
|
Family ID: |
40718469 |
Appl. No.: |
12/789643 |
Filed: |
May 28, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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PCT/US2008/085081 |
Nov 28, 2008 |
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12789643 |
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60991150 |
Nov 29, 2007 |
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61053038 |
May 14, 2008 |
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61091335 |
Aug 22, 2008 |
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61104532 |
Oct 10, 2008 |
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Current U.S.
Class: |
600/201 ;
227/175.1; 606/1; 606/190; 606/205 |
Current CPC
Class: |
A61B 17/00234 20130101;
A61B 2017/2904 20130101; A61B 2017/2905 20130101; A61B 2017/00367
20130101; A61B 17/320016 20130101; A61B 2017/00946 20130101; A61B
17/29 20130101; A61B 2017/00738 20130101; A61B 2017/2929 20130101;
A61B 2017/2927 20130101; A61B 17/07207 20130101; A61B 2017/291
20130101; A61B 2017/2932 20130101 |
Class at
Publication: |
600/201 ; 606/1;
606/205; 227/175.1; 606/190 |
International
Class: |
A61B 1/32 20060101
A61B001/32; A61B 17/28 20060101 A61B017/28; A61B 17/10 20060101
A61B017/10; A61B 17/00 20060101 A61B017/00 |
Claims
1. A surgical instrument adapted and configured for use in
minimally invasive surgical procedures, the surgical instrument
comprising: (a) a shaft having proximal and distal end portions,
the shaft defining a longitudinal axis of the surgical instrument;
(b) an end effector operably connected to the distal end portion of
the shaft, adapted and configured for performing a surgical task;
and (c) a handle portion connected to the proximal end portion of
the shaft, having an actuatable portion operably connected to the
end effector to result in movement of the end effector when
actuated, (d) wherein the distal end portion of the shaft is
laterally offset from the longitudinal axis of the shaft.
2. The surgical instrument of claim 1, wherein the distal end
portion of the shaft is substantially parallel to the proximal end
portion of the shaft.
3. The surgical instrument of claim 1, wherein the distal end
portion of the shaft includes an arcuate portion that deviates from
the longitudinal axis of the shaft.
4. The surgical instrument of claim 3, wherein the arcuate portion
curves in a plane that is substantially orthogonal, with respect to
the longitudinal axis of the shaft, to a plane in which the lateral
jog is formed.
5. A surgical instrument adapted and configured for use in
minimally invasive surgical procedures, the surgical instrument
comprising: (a) a shaft having proximal and distal end portions;
(b) an end effector connected to the distal end portion of the
shaft, adapted and configured for performing a surgical task; and
(c) a handle portion connected to the proximal end portion of the
longitudinal shaft, having an actuatable portion operably connected
to the end effector to result in movement of the end effector when
actuated, (d) wherein the handle portion of the surgical instrument
is arranged at an obtuse angle with respect to the longitudinal
axis of the proximal longitudinal end of the shaft of the surgical
instrument.
6. The surgical instrument of claim 5, wherein the end effector is
one of a surgical stapler, dissector, grasper and retractor.
7. A surgical instrument adapted and configured for use in
minimally invasive surgical procedures, the surgical instrument
comprising: (a) a shaft having proximal and distal end portions;
(b) an end effector connected to the distal end portion of the
shaft, adapted and configured for performing a surgical task; and
(c) a handle portion connected to the proximal end portion of the
longitudinal shaft, having an actuatable portion operably connected
to the end effector to result in movement of the end effector when
actuated, (d) wherein a bend is formed in the shaft, such that the
proximal end portion of the surgical instrument is arranged at an
acute angle with respect to the distal end portion of the surgical
instrument, offsetting the handle from the longitudinal axis of the
distal portion of the shaft.
8. A surgical instrument adapted and configured for use in
minimally invasive surgical procedures, the surgical instrument
comprising: (a) a longitudinal shaft having proximal and distal end
portions; (b) a distal end effector operably connected to the
distal end portion of the shaft, adapted and configured for
performing a surgical task; and (c) a proximal handle portion
connected to the proximal end portion of the longitudinal shaft,
having an actuatable portion operably connected to the end effector
to result in movement of the end effector when actuated, (d)
wherein the handle portion is rotatably connected to the proximal
end portion of the shaft; and (e) the end effector is rotatably
connected to the distal end portion of the shaft, the handle
portion and the end effector being mutually connected such that
relative rotation of the handle portion with respect to the shaft
causes relative rotation of the end effector with respect to the
shaft.
9. The surgical instrument of claim 8, wherein a flexible
connecting member is provided in the shaft to transfer a rotational
force from the handle portion to the end effector.
10. A method of performing a laparoscopic cholecystectomy,
comprising the steps of: a) inserting a single access port through
the abdominal wall of a patient; b) introducing a scope through the
access port; c) inserting a surgical grasper through the access
port; d) lifting the gall bladder with the surgical grasper; e)
inserting a dissector through the access port; f) dissecting the
cystic duct and artery with the dissector; g) inserting a clip
applier and surgical scissor through the access port; h)
terminating the cystic duct and artery with the clip applier; i)
cutting the cystic duct and artery with a surgical scissor; j)
inserting an energy device through the access port; k) dissecting
the gall bladder from the liver bed with the energy device; l)
introducing a specimen bag through the access port; m) removing the
gallbladder from the abdominal cavity with the specimen bag; n)
removing the access port; and o) closing the incision with a
suitable closure.
11. A surgical instrument adapted and configured for use in
minimally invasive surgical procedures, the surgical instrument
comprising: (a) a shaft having proximal and distal end portions,
the shaft defining a longitudinal axis of the surgical instrument;
(b) an end effector operably connected to the distal end portion of
the shaft, adapted and configured for performing a surgical task;
and (c) handle portion connected to the proximal end portion of the
shaft, having an actuatable portion operably connected to the end
effector to result in movement of the end effector when actuated,
(d) wherein the distal end portion of the shaft is arcuately offset
from the longitudinal axis of the shaft.
12. The surgical instrument of claim 11, wherein the distal end
portion of the shaft is additionally laterally offset from the
proximal end portion thereof.
13. The surgical instrument of claim 12, wherein the laterally
offset distal end portion is substantially parallel to the proximal
end portion of the shaft.
14. The surgical instrument of claim 12, wherein the arcuate offset
and lateral offset are formed in mutually orthogonal planes, with
respect to a longitudinal axis of the shaft.
15. The surgical instrument of claim 12, wherein the arcuate offset
and lateral offset are formed in mutually parallel planes, with
respect to a longitudinal axis of the shaft.
16. The surgical instrument of claim 12, wherein the end effector
and actuatable portion of the handle are mutually operably connect
by an actuating element.
17. The surgical instrument of claim 16, wherein the actuating
element is formed of a flexible material.
18. The surgical instrument of claim 16, wherein the actuating
element is a composite element formed of at least two
longitudinally coupled sections.
19. The surgical instrument of claim 16, wherein the actuating
element is formed of a coiled material.
20. A surgical instrument for laparoscopic procedures, the surgical
instrument comprising: a) a handle portion; b) an elongated shaft
extending from the handle portion, the shaft having one or more
bends or curves formed therein; c) an actuating member extending
from the handle through the elongated shaft, the actuating member
including a plurality of axially-connected shaft portions including
rigid and flexible portions; and d) an effector provided on a
distal end of the elongated shaft, operatively connected to the
actuating member for performing a surgical task.
21. The surgical instrument of claim 20, wherein the one or more
bends or curves includes a bend in a proximal portion of the
shaft.
22. The surgical instrument of claim 21, wherein the bend is
between about 30 and 60 degrees.
23. The surgical instrument of claim 20, wherein the one or more
bends or curves includes an arcuate curve in the distal portion of
the shaft.
24. The surgical instrument of claim 20, wherein the one or more
bends or curves are provided in the shaft such that the position of
the handle portion, when the instrument is in a working position,
inserted through a surgical access device, is such that it
approximates the position of a handle of a surgical instrument used
in an open surgical procedure.
25. The surgical instrument of claim 24, wherein the one or more
bends or curves are provided such that when a plurality of
instruments are inserted through a single access device, a portion
of the shaft of the surgical instruments passing through the
surgical access device are mutually substantially parallel, and a
proximal end portion of the surgical instruments extend away from a
longitudinal axis of the respective surgical instrument.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of priority to
International Patent Application No. PCT/US2008/085081, which in
turn claims the benefit of priority to U.S. Patent Application Ser.
No. 60/991,150 filed Nov. 29, 2007, U.S. Patent Application Ser.
No. 61/053,038 filed May 14, 2008, U.S. Patent Application Ser. No.
61/091,335 filed Aug. 22, 2008, and U.S. Patent Application Ser.
No. 61/104,532 filed Oct. 10, 2008. Each of the aforementioned
patent applications is incorporated herein by reference in its
entirety.
FIELD OF THE INVENTION
[0002] The present invention relates to instruments for use in
minimally invasive surgical procedures and methods relating
thereto. Particularly, the present invention is directed to
instruments having an elongated shaft, an actuator at a proximal
end and an effector at a distal end thereof, and to surgical
methods utilizing such devices.
BACKGROUND
[0003] A variety of surgical devices are known in the art to aid in
performing surgical procedures. Typical surgical devices of this
kind are fully rigid, including an elongate shaft rigidly affixed
to a handle at a proximal end thereof. Such handles and any
actuator thereon are typically configured with a pistol-type grip,
as in the case of a surgical stapler, or with a scissor handle, as
in the case of many other devices, such as some graspers, for
example. The handles are typically arranged at the proximal end of
the device, in-line with the longitudinal axis of the device or
deviated therefrom by an acute angle. Examples of such devices are
set forth, for example, in U.S. Pat. No. 7,258,262 to Mastri et al,
U.S. Pat. No. 5,820,009 to Melling et al., U.S. Pat. No. 5,462,558
to Kolsea et al. and U.S. Pat. No. 5,728,121 to Bimbo et al., each
of which documents is hereby incorporated by reference in its
entirety.
[0004] Applicant recognizes, however, that such typical instruments
pose difficulties when used in conjunction with other instruments
in a small space, such as during laparoscopic procedures, and
particularly during such procedures through a single or limited
number of access ports. Under such conditions, typical devices in
the art suffer from interference between handles and/or effector
ends of other such devices.
[0005] Moreover, during laparoscopic surgical procedures, the
movement of the surgical instrument tip is typically restricted to
a region relatively proximal to an axis of a surgical access port,
such as that of a surgical cannula. Typically, this disadvantage is
mitigated through use of multiple access ports distributed across a
patient's abdomen.
[0006] Increasingly, techniques are being developed for performing
minimally invasive surgical procedures through a single access
port. With the advent of such surgeries, it has become necessary to
insert multiple instruments through a single access port.
Accordingly, the relative motion of, and distance between
instrument tips are restricted by the inner diameter of the access
port. With traditional instruments, instrument effector ends can
interfere with one another while also not being capable of reaching
a wide range of areas, or of approaching such areas from different
angles.
[0007] Additionally, as mentioned above, in such procedures with
traditional laparoscopic hand instruments, it becomes difficult to
manipulate the handles at the proximal end (user end) thereof, due
to crowding due from mutual interference between multiple
instrument handles in a relatively small area.
[0008] Certain surgical access devices or access "ports" have been
developed which have particular advantages with single-incision
surgeries, including those devices described in U.S. Pat. Nos.
7,182,752, 7,338,473, and 7,285,112, U.S. Patent Application
Publication Number US 2007/0088275 and PCT Publication Number
WO2008/077080, which documents are fully incorporated herein by
reference. The surgical access devices described in these documents
utilize a non-mechanical pressure sealing capability to prevent
depressurization of the abdominal cavity during laparoscopic
abdominal surgeries. The absence of reliance upon purely mechanical
seals, as is common in traditional surgical access devices, allows
for the simultaneous use of multiple instruments through a single
access device inserted through a single incision, while maintaining
a pressurized abdominal cavity (pneumoperitoneum). Traditional
mechanically-sealed surgical access devices suffer from various
drawbacks when multiple instruments are inserted, or even when a
single instrument is manipulated off axis, usually resulting in
loss of pneumoperitoneum and/or torn seals or other problems.
[0009] Accordingly, Applicant recognizes that there remains a need
in the art for devices that are capable of reduced interference
with other instruments, which facilitate simultaneous use of
multiple instruments in a confined space.
[0010] Furthermore, one objective of the present invention, is to
provide instruments that are particularly suited for use in
single-incision surgeries, which allow for greater freedom of
movement at the proximal end, reducing crowding and allowing the
surgeon an ergonomically advantageous position. Another objective
of the present invention is to provide a surgeon with a greater
range of motion between instrument tips during laparoscopic
surgery, particularly in single-port surgeries. Among other
advantages, instruments in accordance with the invention will
enhance a surgeon's dexterity, reduce fatigue and improve accuracy
during laparoscopic surgical procedures, particularly during
single-incision laparoscopic surgical procedures.
SUMMARY
[0011] The purpose and advantages of the present invention will be
set forth in and apparent from the description that follows. To
achieve these and other advantages and in accordance with the
purpose of the invention, as embodied, the invention includes a
surgical instrument adapted and configured for use in minimally
invasive surgical procedures that includes a longitudinal shaft, a
distal end effector and a proximal handle. The longitudinal shaft
has proximal and distal end portions, and defines a longitudinal
axis of the surgical instrument. The distal end effector is
connected to the distal end portion of the shaft, and is adapted
and configured for performing a surgical task. For example, such
end effector can be a shear, a stapler or of another type. The
proximal handle portion is connected to the proximal end portion of
the longitudinal shaft and has an actuatable portion operably
connected to the end effector to result in movement of the end
effector when actuated.
[0012] If desired, the distal end portion of the shaft can be
laterally offset from the longitudinal axis of the shaft.
Additionally or alternatively, the distal end portion of the shaft
can have an arcuate portion that deviates from the longitudinal
axis of the shaft. The arcuate portion can be formed so as to curve
in a plane that is substantially orthogonal, with respect to the
longitudinal axis of the shaft, to a plane in which the lateral jog
is formed. Alternatively, the arcuate portion can be formed so as
to curve in a plane that is substantially parallel, with respect to
the longitudinal axis of the shaft, to a plane in which the lateral
jog is formed.
[0013] Additionally or alternatively, the proximally arranged
handle portion of the surgical instrument can be arranged such that
it extends away from the longitudinal axis of the shaft of the
surgical instrument.
[0014] In accordance with one aspect of the invention, a method of
performing a laparoscopic cholecystectomy is provided. The method
includes: inserting a single access port through the abdominal wall
of a patient, introducing a scope through the access port,
inserting a surgical grasper through the access port, lifting the
gall bladder with the surgical grasper, inserting a dissector
through the access port, dissecting the cystic duct and artery with
the dissector, inserting a clip applier and surgical scissor
through the access port, terminating the cystic duct and artery
with the clip applier, cutting the cystic duct and artery with a
surgical scissor, inserting an energy device through the access
port, dissecting the gall bladder from the liver bed with the
energy device, introducing a specimen bag through the access port,
removing the gallbladder from the abdominal cavity with the
specimen bag, removing the access port, and closing the incision
with a suitable closure.
[0015] In accordance with a further aspect of the invention, a
surgical instrument for laparoscopic procedures includes a handle,
an elongated shaft extending therefrom, and an effector at a distal
end of the shaft. The shaft includes one or more bends or curves
formed therein. An actuating member extends from the handle through
the elongated shaft, and includes a plurality of axially-connected
shaft portions including rigid and flexible portions. The effector
is provided on a distal end of the elongated shaft, and is
operatively connected to the actuating member for performing a
surgical task.
[0016] The one or more bends or curves can include a bend in a
proximal portion of the shaft. In accordance with the invention,
the bend can be between about 10 and 170 degrees. In accordance
with a preferred aspect, the bend is between about and 20 and 60
degrees. The one or more bends or curves can include an arcuate
curve in the distal portion of the shaft.
[0017] The one or more bends or curves can be provided in the shaft
such that the position of the handle portion, when the instrument
is in a working position, inserted through a surgical access device
in a laparoscopic procedure, for example, is such that it
approximates the position of a handle of a surgical instrument used
in an open surgical procedure.
[0018] The one or more bends or curves can be provided such that
when a plurality of instruments are inserted through a single
access device, a portion of the shaft of the surgical instruments
passing through the surgical access device are mutually
substantially parallel, and a proximal end portion of the surgical
instruments extend away from a longitudinal axis of the respective
surgical instrument.
[0019] If desired, the handle portion can be rotatably connected to
the proximal end portion of the shaft, and the end effector can be
rotatably connected to the distal end portion of the shaft. In this
case, the handle portion and the end effector are mutually
connected such that relative rotation of the handle portion with
respect to the shaft causes relative rotation of the end effector
with respect to the shaft. Accordingly, a flexible connecting
member, such as a cable for example, is provided in the shaft to
transfer a rotational force from the handle portion to the end
effector.
[0020] It is to be understood that both the foregoing general
description and the following detailed description are exemplary
and are intended to provide a non-limiting explanation of the
invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0021] The accompanying drawings, which are incorporated in and
constitute part of this specification, are included to illustrate
and provide a further understanding of the method and system of the
invention. Together with the description, the drawings serve to
explain the principles of the invention, wherein:
[0022] FIG. 1 is a side view of an example surgical hand instrument
constructed in accordance with one aspect of the invention, shown
inserted through a surgical access port;
[0023] FIG. 2 is a side view of the surgical hand instrument of
FIG. 1, with the surgical access port absent;
[0024] FIG. 3a is an isometric view of a surgical hand instrument
in accordance with the invention, including a lateral jog formed in
the shaft thereof;
[0025] FIG. 3b is an isometric view of a surgical hand instrument
in accordance with the invention, including a lateral jog formed in
the shaft thereof and an arcuately curved distal shaft portion;
[0026] FIGS. 4 and 5 are side views of example shaft constructions
of surgical hand instruments in accordance with the invention,
having arcuately curved distal shaft portions combined with
proximal bends formed in the shafts thereof;
[0027] FIG. 6a is a side view of a surgical hand instrument in
accordance with the invention having a shaft construction having an
arcuately curved distal shaft portion combined with proximal bend
formed in the shaft thereof;
[0028] FIG. 6b is an isometric view of the surgical hand instrument
of FIG. 6a;
[0029] FIG. 7 is a side view of two surgical hand instruments shown
in FIG. 6a, inserted through a surgical access device;
[0030] FIGS. 8a and 8b illustrate side and isometric views of a
surgical instrument in accordance with the invention, in open and
closed positions, respectively;
[0031] FIG. 8c is an isometric view of the surgical instrument of
FIGS. 8a and 8b;
[0032] FIGS. 9a and 9b illustrate side and isometric views of a
surgical instrument in accordance with the invention, in open and
closed positions, respectively;
[0033] FIG. 9c is an isometric view of the surgical instrument of
FIGS. 9a and 9b;
[0034] FIGS. 10-12 are cross-sectional views of example shaft
constructions for surgical instruments in accordance with the
invention;
[0035] FIG. 13-15 are cross-sectional views of further example
shaft constructions for surgical instruments in accordance with the
invention; and
[0036] FIGS. 16-18 are side views of surgical instruments having
alternative handle and effector end constructions, in accordance
with the invention.
DETAILED DESCRIPTION
[0037] Reference will now be made in detail to the presently
preferred embodiments of the invention, examples of which are
illustrated in the accompanying drawings.
[0038] The devices and methods presented herein may be used for
minimally invasive surgical procedures, but may be used for more
conventional surgical procedures. The present invention is
particularly suited for use in minimally invasive surgical
procedures performed through a single or limited number of access
ports, when multiple instruments are required at the same time.
[0039] For the purposes of explanation and illustration, and not
limitation, a side view of an exemplary embodiment of the surgical
hand instrument in accordance with the invention is shown in FIG.
1, where the surgical instrument is inserted through a surgical
access port 190. The surgical access port 190 can be any suitable
type, but in accordance with one aspect of the invention preferably
includes a fluidic seal, such as those described in U.S. Pat. Nos.
6,030,402, 6,056,766, 6,447,527, 7,182,752, 7,285,112 and U.S.
Patent Publication No. 2007/0088275, which documents are
incorporated herein by reference in their entirety. The surgical
hand instrument is designated generally by reference character 100.
FIG. 2 illustrates a similar surgical hand instrument 200 with the
surgical access port 190 absent.
[0040] As shown in FIGS. 1 and 2, the surgical hand instruments
100, 200 are each adapted and configured for use in minimally
invasive surgical procedures and each include a longitudinal shaft
130, 230, a distal end effector 120, 220 and a proximal handle 110,
210.
[0041] The longitudinal shaft 130 has proximal and distal end
portions and defines a longitudinal axis 137 of the surgical
instrument 100. The distal end effector 120 is connected to the
distal end portion of the shaft 130, and is adapted and configured
for performing a surgical task. For example, such end effector 120
can be a shear as illustrated in FIGS. 1 and 2, a stapler or any
effector desired. The proximal handle portion 110 is connected to
the proximal end portion of the longitudinal shaft 130 and has a
stationary portion 113 and an actuatable portion 115 operably
connected to the end effector 120 to result in movement of the end
effector 120 when actuated by a surgeon. If desired, the distal end
portion 135 of the shaft 130 can be laterally offset from the
longitudinal axis of the shaft.
[0042] As illustrated in FIG. 1, the distal end portion of the
shaft 130 is offset by a distance 139 from the longitudinal axis
137. As illustrated, the distal end portion 135 of the shaft 130 is
arcuate in shape, but can be more angularly configured, as with
straight sections if necessary. Naturally, the distal end portion
135 need not be curved at all, and can be straight and in-line with
the longitudinal axis 137.
[0043] Moreover, in the illustrated embodiment, the distal end
portion 135 of the shaft 130 curves back toward the longitudinal
axis 137, leaving the end effector 120 essentially where it would
have been if no deviation were present in the shaft 130.
Alternatively, if so-desired, the end effector 120 can remain
laterally offset from the longitudinal axis 137, rather than
returning to a laterally central position.
[0044] Further, as illustrated, the distal end of the shaft end
portion 135 and the end effector 120 terminate at an angle of .phi.
(phi) with respect to the longitudinal axis 137. This angle can
range from an acute angle of about 0 degrees to an angle of about
180 degrees and can be at any one-degree increment therebetween, as
desired for the particular application. As illustrated in FIG. 1,
the angle .phi. (phi) is about 100 degrees. If so desired, the end
effector 120 and/or the shaft distal end portion 135 can be
adjustable such that the angle .phi. (phi) is adjustable. Although
the shaft 130 is preferably substantially rigid, the shaft may
instead be fully or partially flexible, such as at its distal end
portion 135, to allow for adjustability in different situations
[0045] Moreover, the overall width 180, due to the offset 139 and
the angle of the end effector 120 is preferably selected such that
it is no greater than the largest diameter of the access port being
used. Naturally, when multiple such instruments are inserted, the
space available for insertion of the end effector through the
access port must be considered. In such an instance, a flexible
shaft portion can allow for adjustment of the end effector once
inserted through the access port. Devices in accordance with the
invention can advantageously be used with access ports having major
and minor axes, such as an elliptically-shaped access port. The
extra width available can allow for instruments constructed in
accordance with the invention to pass more easily therethrough.
[0046] With reference to FIG. 2, although applicable to any
embodiment set forth herein, the proximal handle portion 210 (as
well as handle portion 110 of the embodiment of FIG. 1), are
oriented at an angle .beta. (beta) with respect to the longitudinal
axis 237 of the surgical hand instrument 200. As illustrated, this
angle .beta. (beta) is obtuse. The angle can be any angle desired
between about 0 and 180 degrees, but is preferably between about 90
degrees and 145 degrees. In a preferred embodiment, the angle is
about 135 degrees. Additionally, the proximal handle portion 210
can be configured such that the angle .beta. (beta) is adjustable.
Such adjustability may further reduce mutual interference between
adjacent instruments, and can further improve ergonomics for the
user, allowing the user to position the handles in the most
comfortable position for the procedure or specific situation.
[0047] This offset of the handle portion 110, 210 and/or end
effectors 120, 220, allows for reduced interference between
instruments during use, particularly when they are concurrently
inserted through a single surgical access port.
[0048] Additionally, as illustrated in the embodiment of FIG. 2,
the stationary portion 213 and the actuatable portion 215 of the
handle 210 can be rotatably attached to the remainder of the handle
portion 210 by way of a joint element 217. This, in-turn, can be
connected through the shaft 230 by way of any suitable element,
such as a cable or other flexible member to impart rotational force
from the handle 210 to the end effector 220. The end effector 220
can be, in-turn, rotatably attached to the distal end portion 235
of the shaft 230 by way of a joint 236, allowing relative rotation
between the shaft 230 and the end effector 220. In either of the
embodiments of FIG. 1 and FIG. 2, the end effector 220 can be
actuated normally, by moving the actuatable portion 215 of the
handle 210 relative to the stationary portion 213.
[0049] End effectors which may be used with devices constructed in
accordance with the invention include but are not limited to clip
appliers, staplers, morcellators, dissectors, shears, graspers,
suturing devices, ligating loops, specimen retrievers, retractors,
biopsy punches, probes, irrigation cannulas, scissors, forceps,
needle holders, electrocautery devices, coagulating devices, and
clamps. In accordance with any embodiment of the invention, the end
effector and instrument can be configured such that the end
effectors are interchangeable. That is, the end effectors can be
removable and replaceable with the same or different type of end
effector.
[0050] Although illustrated and described as being actuatable only
by hand, devices in accordance with the invention can be modified
so as to be used in conjunction with robotic surgical systems. In
this case, the proximal handle portion (110, 210) is replaced with
a suitable engaging and interface portion to adapt the surgical
instruments described herein for use with such systems.
[0051] Devices constructed in accordance with the invention can
facilitate various minimally invasive surgical procedures using a
minimal number of access ports, including cholecystectomy, sleeve
gastrectomy, nephrectomy, colon resection, hysterectomy,
appendectomy, oophorectomy, or mass removal.
[0052] For example, a laparoscopic cholecystectomy, in accordance
with one aspect of the invention, includes a first step of
inserting a single access port through the umbilicus or in another
location in the abdomen of the patient. As set forth above, the
access port, in accordance with one aspect of the invention,
includes a fluidic seal. Such access ports can be relatively large
in size to accommodate multiple instruments, and be circular or
non-circular in cross-section, including oval, for example.
Diameters or axial dimensions, in accordance with one aspect, are
in the range of about 12 mm to about 25 mm. Larger sizes allow for
insertion of more and/or larger instruments, and facilitate tissue
removal through the port.
[0053] Subsequently, a scope can be introduced through the access
port, which may be a flexible endoscope or laparoscope, for
example. All subsequent steps can be performed by inserting the
appropriate instrument or instruments through the access port. In
the case of a cholecystectomy, the gallbladder can be lifted with
surgical grassers or another suitable instrument. The cystic duct
and artery can then be dissected with a suitable instrument, such
as a dissector. The cystic duct and artery can be terminated, for
example, clipped with a clip applier and cut with a suitable
instrument, such as a surgical scissor.
[0054] The gall bladder can then be removed, and is dissected from
the liver bed prior to removal with a suitable instrument, such as
an energy device, which can be a cautery device or harmonic device,
for example. Subsequently, a specimen bag can be introduced to
remove the gallbladder from the abdominal cavity. Upon completion
of the procedure, the access port can be removed, and the incision
can be closed with sutures or by another suitable closure.
[0055] A sleeve gastrectomy can be performed in accordance with the
invention including the steps of inserting the required number of
access ports, but preferably only a single port, in the abdomen of
a patient, such as through the umbilicus as set forth above. The
method can further include introducing a scope, and transecting
small gastric vessels with a grasper and energy source, for
example. An energy source can include ultrasonic, Ligasure.TM.
(Manufactured by ValleyLab, a division of Tyco Healthcare Group LP)
or bipolar energy sources, for example. Further steps included in
accordance with this aspect are retracting the stomach laterally,
sizing a sleeve such as by inserting a bougie via the mouth,
transecting the stomach, such as with a surgical stapler, removing
a specimen or excess tissue, with graspers, for example, and
finally removing the access port and closing the incision made to
insert the access port.
[0056] A nephrectomy can be performed in accordance with the
invention, including the steps of inserting a port and inserting a
scope therethrough, as set forth above, dissecting and exposing the
kidney, such as with dissectors, scissors and/or an energy source,
ligating and transecting the ureter, such as with clips and
scissors, and transecting renal vessels, such as with a surgical
stapler or other suitable instrument. The method further includes
removing the kidney such as with a specimen bag and/or through use
of a morcellator. The procedure is completed by removing the access
port and closing the incision made therefor, with sutures or other
suitable closure.
[0057] A colon resection performed in accordance with one aspect of
the invention includes the steps of inserting a port and inserting
a scope therethrough, as set forth above, mobilizing the colon with
a suitable instrument such as graspers, scissors, dissectors and/or
an energy source, for example. The method can further include
ligating the blood supply with a stapler and/or an energy source,
for example, and transecting and removing the desired portion of
the colon using a surgical stapler and a specimen bag, for example.
Next, anastomosis can be performed using a surgical stapler, which
can be an EEA stapler, and then the access port can be removed and
the incision can be closed.
[0058] A laparoscopic hysterectomy can be performed in accordance
with one aspect of the invention in the following steps: First, a
single port is inserted into the abdominal cavity, such as through
the umbilicus, as set forth above, followed by insertion of a scope
therethrough. Next, the uterus is mobilized and the blood supply
thereto is ligated and transected, using a grasper, energy source
and/or surgical stapler, for example. Subsequently, the uterus can
be removed vaginally, or alternatively can be removed through the
access port. In the latter instance, a morcellator is preferably
utilized to facilitate removal. Finally, the access port is
removed, and the incision is closed.
[0059] In accordance with another aspect of the invention, an
appendectomy can be performed laparoscopically, including the steps
of inserting an access port and scope into the abdominal cavity, as
set forth above, then grasping and exposing the appendix with a
suitable instrument, such as surgical graspers. Subsequently, the
mesoappendix is ligated, such as with a surgical stapler or energy
source, the appendix is transected with a suitable instrument, such
as a surgical stapler, the appendix is removed with a specimen bag,
and the port is removed and the incision closed with sutures or
other suitable closure.
[0060] An oophorectomy or mass removal can be accomplished
laparoscopically in accordance with the invention, including the
steps of inserting a port and scope as set forth above, exposing
the ovary or mass with a suitable instrument, such as a surgical
grasper, mobilizing the ovary/mass with dissectors, scissors or
other suitable instrument, and ligating and transecting the
ovary/mass with a suitable instrument, such as an energy source or
surgical stapler.
[0061] In accordance with the invention, any of the foregoing
methods can include more or fewer steps, and can include steps or
utilize instruments that vary from those specifically set forth
herein.
[0062] Additionally, in accordance with a preferred aspect of the
invention, the abdominal cavity is insufflated during the
procedures set forth above. Naturally, this can be accomplished in
a conventional manner, such as with a veress needle. Alternatively,
the access port can be adapted and configured to provide
insufflation to the abdominal cavity.
[0063] In accordance with further aspects of the invention, the
shafts of laparoscopic instruments designed and constructed in
accordance herewith are curved, bent or otherwise offset in one or
more planes. In accordance with one aspect, for example, bends
and/or curves are formed in orthogonal vertical and horizontal
planes.
[0064] For example, and as illustrated in FIGS. 3a and 3b, in
accordance with one aspect of the invention, a laparoscopic
surgical instrument 300 has a main shaft 310, a proximal handle 340
and a distal effector end 330. The main shaft 310, as illustrated,
has an integral jog formed therein such that the axis of the distal
shaft portion 315 end is parallel to, but offset from the axis of
the proximal end 311 of the instrument shaft. As illustrated
particularly in FIG. 1, an angled shaft portion 313 between the
proximal and distal shaft portions can be provided to offset the
axis of the instrument. Accordingly, such a surgical instrument can
be configured such that a rotation of the surgical instrument, or
alternatively only the shaft thereof, results in a rotational and
translational displacement of the effector end. Such instruments
can be additionally configured so that rotation of another element,
such as the handle 340 or a separate knob, for example, causes the
effector end itself to rotate with respect to the shaft 310,
further increasing dexterity.
[0065] Accordingly, in an embodiment such as that illustrated in
FIGS. 3a and 3b, one or more instruments can be inserted through a
surgical access port, and one or more of the shafts can be rotated,
to move the distal (effector) end 330 of the instrument toward or
away from the central axis of the access port, and accordingly
toward or away from other surgical instruments being used at the
same time. When rotated, the distance traveled is proportional to
the product of the magnitude of the offset caused by the bent shaft
portion 313 and the angle of rotation of the shaft. Accordingly,
the proximal end of the instrument at the handle may be stationary,
while the distal (effector) end 330 is displaced by a relatively
large distance. Effector ends 330 for instruments in accordance
with the invention can include any desired surgical tool, including
but not limited to surgical graspers, dissectors scissors,
scalpels, clamps and cautery devices.
[0066] In accordance with this aspect of the invention, the
positioning of the jog in the shaft, causing lateral displacement
of the distal portion 315 of the surgical instrument shaft 310 from
the proximal portion 311 of the shaft 310, occurs in a location
that is selected to be just distal to the end of the access port
when in use. Accordingly, an instrument can advantageously be
inserted through the access port, and then rotated out of the way,
while another instrument is inserted, for example.
[0067] Additionally or alternatively, in accordance with the
invention, and as illustrated in FIG. 1, the distal portion 315 of
surgical instruments 300 in accordance with the invention can
include an arcuate bend formed therein. The effector end 330,
and/or the distal portion of the shaft 315 near the effector end
330, can optionally be bent or otherwise configured so as to
provide further dexterity of the surgical instrument. In accordance
with the invention, the lateral jog caused by a bent shaft portion
313 can be combined with the arcuate curve of the distal shaft
portion 315, as shown in FIG. 3b, for example. As shown in FIG. 3b,
the arcuate curve can be formed in a plane parallel to that in
which the lateral jog is formed. Alternatively, the arcuate curve
can be formed in a plane orthogonal to that in which the lateral
jog is formed.
[0068] In such an arrangement, effector ends 330 of each of a pair
of surgical instruments used in conjunction (as illustrated in FIG.
7, for example) inserted through an access port (e.g. access port
770) are able to triangulate with one another. If the shafts of the
two instruments are rotated in opposite directions, the distal
effector ends move apart by twice the distance of the individual
offsets, proportional to the angle of rotation. Such ability is
particularly advantageous in a scenario in which multiple surgical
instruments are needed simultaneously in a surgical access port,
which situation increasingly or completely inhibits relative
cross-axis translation.
[0069] In accordance with a further aspect of the invention, a
surgical instrument in accordance with the invention can be
intentionally laterally restrained within a surgical cannula for
the purpose of providing additional stability of the instrument,
for example. In such an arrangement, the subject instruments can be
configured and adapted to rotate, and optionally move inward and
outward (axially), but inhibit lateral translation. However, with
the configuration of the subject instruments, rotational movement
results in translational movement, thereby allowing for additional
stability without severely inhibiting dexterity.
[0070] In accordance with another aspect of the invention, and as
illustrated in FIGS. 4-7, for example, there is illustrated a
laparoscopic surgical instrument having a main shaft with a
proximal angularly offset or "bent" portion 417, 517, a handle
portion (e.g. 640) attached to the proximal angularly offset
portion 417, 517 of the shaft 410, 510, an optional arcuately
curved distal shaft portion 415, 515, and an effector (e.g. 630)
operably connected to the distal end portion 415, 515 of the shaft
410, 510. The foregoing arrangement of an angularly offset handle,
particularly in combination with an arcuately curved distal
portion, allows for reduced interference between multiple
instruments used at the same time.
[0071] Although variations in the specific dimensions are possible,
and contemplated by applicants, as illustrated in FIG. 4, the
overall length L1 of the instrument 400 is about 45 cm. The length
L3 of the angularly offset proximal shaft portion 417 is about 10
cm. The length L2 of the main shaft 411 is about 20 cm. The radius
R1 of the arcuately curved portion 415 is about 45 cm. The shaft
thickness t1 is about 0.5 cm, and the width W1 of the shaft 410,
taking into account the added width due to the arcuate portion 415
is about 1.2 cm. The angle .theta.1 between the axis of the main
shaft portion 411 and the proximal angularly offset portion 417 is
about 30 degrees. Naturally, these values are for the purpose of
providing an example, and the instrument can be embodied with
actual values that differ slightly or greatly from the foregoing
values.
[0072] The embodiment of the surgical instrument 500 illustrated in
FIG. 5 is similar to the embodiment of FIG. 4, but with a more
shallow curvature being provided to the distal curved portion 515
of the shaft 510. The overall length L4 of the instrument 500 is
about 45 cm. The length of the angularly offset proximal shaft
portion 517 is about 10 cm. The length L5 of the main shaft 511 is
about 26 cm. The radius R2 of the arcuately curved portion 515 is
about 16.5 cm. The shaft thickness t2 is about 0.5 cm, and the
width W2 of the shaft 510, taking into account the added width due
to the arcuate portion 515 is about 1.25 cm. The angle .theta.2
between the axis of the main shaft portion 511 and the proximal
angularly offset portion 517 is about 30 degrees. Naturally, these
values are for the purpose of providing an example, and the
instrument can be embodied with actual values that differ slightly
or greatly from the foregoing values.
[0073] In accordance with one aspect of the invention, and as
illustrated for example in FIGS. 6a and 6b, the relative angle
.alpha.1 (alpha 1) between the central axis 591 of the instrument
500 and the angularly offset proximal shaft portion 517 is about
the same as the relative angle .alpha.2 (alpha 2) between an axis
595 of the effector end 630 and the central axis 591 of the
instrument 500. In accordance with one preferred embodiment, the
angles .alpha.1, .alpha.2 are each about 30 degrees. Naturally,
however, the angles .alpha.1, .alpha.2 can vary from that magnitude
as desired or required. Moreover, the angles can be embodied such
that they are adjustable. This can be accomplished by utilizing
malleable materials and/or through use of an angularly adjustable
shaft 510.
[0074] If so desired, the proximal handle 640 can be formed so as
to have an angular offset, with respect to the proximal shaft
portion 517, in order to augment the relative angle formed between
the main shaft 511 and the proximal shaft portion 517. Further,
angular adjustability can be provided at this point as well, to
allow the user to determine the most comfortable position for the
handle 640.
[0075] FIG. 7 illustrates two laparoscopic surgical instruments 500
designed and constructed in accordance with the invention, and as
described above in connection with FIGS. 5, 6a and 6b. As can be
seen, both surgical instruments 500 are inserted though an access
port 770, which in-turn, in use would ordinarily be inserted
through an incision formed in a patient, typically through the
patient's abdominal wall, for example.
[0076] As illustrated, a relative angle .beta.1 is formed between
the proximal angularly offset portions 517 of the shafts thereof,
as is a relative angle .beta.2 formed between the axes of the
distal effector ends 630. Although these angles can be any
particular value needed or desired, in accordance with one aspect
of the invention, these angles are about the same, and range
between about 30 and about 60 degrees. In accordance with one
embodiment, the angles .beta.1, .beta.2 are about 45 degrees.
[0077] Instruments designed and constructed in accordance with the
invention, used in conjunction as illustrated in FIG. 7, or with
conventional laparoscopic instruments, allow for reduced
interference between the instruments being used. In use, there is a
reduced need for manipulating instruments so that they cross the
central axis of the access device 770. This advantageously reduces
the obstruction of the surgeon's view through an endoscope or other
viewing device. Additionally, the separation of the handles 640
afforded by the angularly offset proximal portion 517 of the shaft
510, in combination with an advantageous orientation between the
effector ends 630, reduces or completely eliminates the need for a
surgeon to cross his or her arms while performing a procedure.
[0078] In use, the perception by the surgeon is, to an extent, as
if the surgical site were open, located at the intersection of the
proximal angularly offset portions of the instrument shaft, but
displaced vertically therefrom. Accordingly, the movements of the
surgeon need not be substantially different from those he or she
would use when performing an open surgery. Therefore, the
difficulty level is reduced and the speed of training is increased.
Additionally, because of the ergonomically advantageous position of
the handles 517 with respect to the patient, fatigue on the surgeon
is reduced.
[0079] In accordance with the invention, the handle 517 can actuate
the effector end 630 in any suitable manner. The handle 517 is
preferably connected to the effector end by way of an actuating
element that is capable of exerting tension and/or compression
without buckling or fatiguing during the life of the instrument.
Such element is also preferably somewhat flexible to allow passage
through bent and/or curved portions of the shaft, as will be
discussed in more detail below.
[0080] The actuating element can be of any suitable material, but
is preferably formed of a flexible metal or semi-rigid polymeric
material. The actuating element can be substantially rod shaped,
and can have a substantially circular cross section, for example.
The actuating element can be a soft metal rod, such as one formed
of a flexible metal alloy. Alternatively, the actuating element can
be a semi-rigid coil, which is relatively stiff in resistance to
axially-applied forces, but which allows movement through the bends
and curves formed in the surgical instrument. The cross section,
moreover can be either solid or tubular, as required for strength.
The actuating element can be formed wholly or in part by a braided
material, such as a braided cable made of a metal or polymer. The
actuating element can also be restrained laterally to reduce
buckling of the element laterally in compression.
[0081] FIGS. 8a, 8b, 8c, 9a, 9b and 9c illustrate side and
isometric views of surgical instruments 800, 900, in open and
closed positions, respectively. As illustrated, surgical
instruments 800 and 900 differ in that the internal angle .gamma.1,
.gamma.2 (gamma 1, gamma 2) between an axis of the main shaft 811,
911 of the instrument and the effector ends 830, 930, respectively,
is more acute in the instrument 900 of FIGS. 9a-c. That is,
.gamma.2 is less than .gamma.1, as illustrated. In accordance with
the invention, preferred fixed angles for .gamma.1 and .gamma.2 are
between about 90 degrees and 180 degrees. In still further
preferred embodiments, the fixed angles (.gamma.1, .gamma.2) are
between about 130 and 155 degrees. In still preferred embodiments,
one or more of the fixed angles (.gamma.1, .gamma.2) is about 135
degrees, and in still other preferred embodiments, one or more of
the fixed angles (.gamma.1, .gamma.2) is about 150 degrees.
[0082] In accordance with a preferred aspect of the invention, as
illustrated in FIGS. 8a-c and 9a-c, for example, the actuating
element 860 can be a compound element. As illustrated, the
actuating element 860 includes multiple coupled sections including
a first linear element 860a, a first flexible element 860b, and a
second linear element 860c. If a curved distal shaft portion is
provided, as with the embodiments of FIGS. 4 and 5 for example,
further flexible portions can be provided as needed. Coupling of
linear and flexible elements can be effected in any suitable
manner, including but not limited to use of a cuff, sleeve or
spline, for example. Alternatively, if the materials used are
compatible, welding, such as solvent, heat or arc welding, brazing,
gluing (as with an adhesive or the like), or other suitable
techniques can be used.
[0083] In accordance with the invention, and as set forth above,
the flexible elements (e.g. 860b) can be formed from a suitable
flexible material, which can include a solid, tubular, coiled or
braided element, for example. In accordance with a preferred
aspect, the flexible elements include sufficient flexural and/or
torsional rigidity to efficiently transfer forces between the
handle 840 and the effector 830 without buckling or twisting while
still allowing for bending when urged longitudinally through one or
more bends in the shaft 810.
[0084] In accordance with the invention, the linear elements (e.g.
860a, 860c) can be of any suitable configuration, and made of any
suitable material, including those set forth above. For example,
the linear elements 860a, 860c can be solid, tubular, coiled,
braided or woven, for example. In accordance with a preferred
aspect, the linear elements 860a, 860c are solid or tubular and
substantially cylindrical in shape. In any case, the linear
elements are preferably relatively stiff in compression, so as to
inhibit buckling of the actuating element 860 in compression. If
so-embodied, as described in more detail below, the actuating
element 860, and particularly the linear elements thereof are also
relatively stiff in torsion, so as to provide a relatively quick
and accurate response to torsional actuation inputs.
[0085] As best seen in the enlarged partial views of the distal end
effectors 830, 930 of FIGS. 8a-8c and 9a-9c, the shaft of the
actuating element 860 terminates at a link 867, connected thereto
with a first pivot 866, such as a pin, which is connected to jaws
831 by way of a second pivot 868. The jaws 831 are closed with
respect to one another by exerting a proximally-directed force on
the second pivot 868. The proximally-directed force pulls the
actuating elements proximally (toward the left in the figures),
causing the jaws 831 to ride on a axially stationary cam pin 873,
by virtue of cam slots 835 defined in the jaws 831. Accordingly,
there is a slight proximal movement of the jaws 831 when they are
closed.
[0086] As mentioned briefly above, in the embodiments of FIGS.
8a-8c and 9a-9c, the effectors 830, 930 of the instrument 800, 900
are supported by a distal elbow housing 870, 970. The elbow housing
can be preformed with a desired bend, with the relative angle
.gamma. between the straight shaft 811 and effector being between
about 90 and 180 degrees. In the embodiment of FIGS. 8a and 8b, the
angle .gamma.1 is about 150 degrees and in the embodiment of FIGS.
9a-9c, the angle .gamma.2 is about 135 degrees. Alternatively, the
distal housing 870 can be essentially straight, and the effectors
830, 930 can be configures to articulate angularly toward and away
from the axis of the instrument.
[0087] The cam pin 873 can be integrally formed or otherwise
mounted in the distal elbow housing 870. Moreover, the distal elbow
housing 870 can be adapted to be rotatable with respect to an axis
of the shaft 811. Accordingly, the housing 870 can be secured to a
tubular member provided on top of or within a skeletal shaft of the
instrument 800, 900.
[0088] FIG. 10 illustrates a simple shaft construction in which an
outer tubular shaft 1012 acts as a skeleton for an instrument (e.g.
instrument 800) in accordance with the invention, helping the
instrument maintain its shape, including any bends, curves or other
features. The shaft of the actuating element 860 is arranged within
a lumen of the tubular shaft 1012, and can be adapted for axial
and/or rotational movement, relative to the tubular shaft 1012,
depending on the precise embodiment. As set forth above, the
actuating element can be solid or tubular, for example, and can be
formed from an extruded, coiled, braided, woven or formed of
another suitable construction.
[0089] FIG. 11 illustrates a shaft construction adapted to permit
axial rotation of a distal component, such as the distal housing
870, for example. In the shaft construction of FIG. 11, an outer
tubular shaft 1112 serves as a skeleton for an instrument to
maintain its shape. The tubular shaft 1112 is again provided on the
outer surface, as with the embodiment of FIG. 10, but an inner
rotatable sleeve 1114 is provided and is connected to the distal
housing 870 for effecting rotation thereof. The connection can be
made in any suitable manner, depending on the material selection.
The inner sleeve 1114 can be formed of a polymeric material, or
alternatively, another suitable material such as a resilient metal
can be used. In this embodiment, the actuating element 860 resides
axially internal to the rotatable sleeve 1114. Accordingly,
friction and/or interference-reducing elements can be incorporated,
including but not limited to spacer bushings placed between
concentric elements, low friction materials, and/or one or more
decoupling sleeves to reduce interference between adjacent active
components, which sleeve(s) may be made of or coated with a low
friction material such as PTFE, for example.
[0090] Alternatively, as illustrated in FIG. 12, a shaft
construction adapted to permit rotation of a distal component can
include a tubular shaft 1212 serving as a shape-maintaining
skeleton arranged intermediate the actuating element 860 for
actuating the effector end 830, and an outer sleeve 1214 connected
to the distal housing 870 for effecting rotation thereof. In such
an embodiment, a distal housing can be rotationally coupled to the
outer sleeve 1214, while being supported by the inner tubular shaft
1212. As shown in the enlarged partial views of FIGS. 8a-9b, the
distal housings 870, 970 can include an axially inwardly-directed
annular boss 879 to maintain the position of the housing 870, while
the outer sleeve 1214 is rotationally coupled to the housing
870.
[0091] FIG. 13a-b, 14a-b and 15a-b illustrate respective example
shaft constructions in accordance with the invention, shown in
cross-section at a bend in the shaft through which the respective
actuating element 860 passes. FIGS. 13a-13b illustrate an actuating
element 860, where the actuating element includes an intermediate
flexible portion 1360. The flexible portion allows the actuating
element 860 to transmit forces across the illustrated bend or other
non-linear region, for example. The flexible portion 1360 can be a
flexible solid material, a flexible tubular material, or a woven or
braided material, for example. The flexible portion 1360 can be a
polymeric, metallic, composite or other suitable material. As
illustrated in FIGS. 14a-14b, a flexible portion 1460 is a coiled
material, and as illustrated in FIGS. 15a-15b, the entire actuating
element is formed of a material and construction that is
sufficiently flexible so as to allow the transmission of
longitudinal and/or rotational forces therethrough. With any of the
foregoing shaft constructions and elements thereof, materials used
are selected so as to have appropriate strength and flexibility,
and can be formed of polymeric, metal, ceramic or composite
materials, for example. Such materials can include but are not
limited to metals and metal alloys including steel, titanium
alloys, nickel alloys, copper alloys, shape memory alloys such as
nitinol, polymers such as PTFE, polyethylene, polyurethane,
composites such as fiberglass, carbon fiber materials, and the
like.
[0092] Referring again to FIGS. 8a-9b, for the purpose of providing
an example, a first knob 849 or other actuator can be provided in
the handle 840 and coupled to an element such as the outer sleeve
1212 to allow manipulation thereof by the surgeon. It is conceived
that the internal actuating element 860 is connected to the movable
handle portion 841 by way of a lever arrangement, and engaged
therewith by way of a spool-shaped bushing 843 or other suitable
connection. An adjustable stop 847 can be provided on the proximal
end of the handle 840 as an extension of the internal actuating
element 860, to maintain or limit the movement of the actuating
element 860, and thus the effector 830. The adjustable stop 847 can
be positioned to maintain the effector in a closed position--that
is, "locked" closed. Applicants further conceive that there are
alternative modes for achieving the desired relative motion of the
moving components of instruments (e.g. 800, 900) of the invention,
and the foregoing embodiment is therefore not intended to be
exhaustive or limiting in any way.
[0093] As set forth above, the instrument 900 of FIGS. 9a-9c
differs from the instrument 800 of FIGS. 8a-8c primarily in that
the bend formed in the distal housing 970 thereof is more extreme
(that is, more acute) than in that of the housing 870 of the
instrument 800 of FIGS. 8a-8c. Accordingly, the link 967 within the
housing 970 is provided with an integral bend to facilitate axial
movement through the housing 970. The manner in which the axial
movement of the internal actuating element 860 actuates the jaws
931 of the effector 930 is similar to that of the instrument 800 of
FIGS. 8a-8c, and as described above.
[0094] FIGS. 16-18 illustrate various alternative handle and/or
effector configurations for surgical instruments, in accordance
with the invention. FIG. 16 illustrates an instrument 1300 having a
fixed angle effector 1630, arranged at about 90 degrees with
respect to the instrument shaft 1610. The handle 1640 of the
instrument 1600 is elongated to provide mechanical advantage to the
user. A ratchet mechanism is optionally incorporated into the
instrument to reduce fatigue of the surgeon.
[0095] FIG. 17 illustrates a laparoscopic surgical instrument 1700
having a switch 1749 arranged in a handle 1740, which switch
operates the effector 1730 by way of electrical, electro-pneumatic,
or pneumatic actuation, for example. Use of an external source of
energy (e.g. electrical or pneumatic) can be implemented to reduce
surgeon fatigue. A relatively small force applied by the surgeon
thus results in a potentially strong force at the effector 1730. In
accordance with one embodiment of this aspect of the invention, the
switch 1749 activates a solenoid to allow pressurized gas to enter
a cylinder. The pressure urges a piston axially to actuate the
effector 1730.
[0096] FIG. 18 illustrates two instruments 1800a, 1800b having
elongated actuating levers 1840a, 1840b, respectively to provide a
mechanical advantage to the surgeon to reduce fatigue. The
orientation of the levers 1840a, 1840b also reduces the overall
sizes of the instrument handles, reducing interference between
adjacent instruments.
[0097] The devices and methods of the present invention, as
described above and shown in the drawings, provide instruments and
surgical procedures that are versatile and facilitate use of
multiple instruments in a confined space and through a single
access port, if necessary or desired. It will be apparent to those
skilled in the art that various modifications and variations can be
made to the devices of the present invention without departing from
the spirit or scope of the invention. Thus, it is intended that the
present invention include such modifications not specifically set
forth herein.
* * * * *