U.S. patent application number 13/042656 was filed with the patent office on 2011-06-30 for surgical access port with embedded imaging device.
This patent application is currently assigned to Avantis Medical Systems, Inc.. Invention is credited to Lex Bayer, Jack Higgins.
Application Number | 20110160535 13/042656 |
Document ID | / |
Family ID | 39030213 |
Filed Date | 2011-06-30 |
United States Patent
Application |
20110160535 |
Kind Code |
A1 |
Bayer; Lex ; et al. |
June 30, 2011 |
SURGICAL ACCESS PORT WITH EMBEDDED IMAGING DEVICE
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.
Inventors: |
Bayer; Lex; (Palo Alto,
CA) ; Higgins; Jack; (Los Altos, CA) |
Assignee: |
Avantis Medical Systems,
Inc.
Sunnyvale
CA
|
Family ID: |
39030213 |
Appl. No.: |
13/042656 |
Filed: |
March 8, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11834540 |
Aug 6, 2007 |
7927272 |
|
|
13042656 |
|
|
|
|
60835543 |
Aug 4, 2006 |
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Current U.S.
Class: |
600/109 ;
600/114 |
Current CPC
Class: |
A61B 1/05 20130101; A61B
1/00154 20130101; A61B 90/37 20160201; A61B 2017/3454 20130101;
A61B 2090/3614 20160201; A61B 1/3132 20130101; A61B 2017/00221
20130101; A61B 17/3421 20130101; A61B 17/3417 20130101 |
Class at
Publication: |
600/109 ;
600/114 |
International
Class: |
A61B 1/32 20060101
A61B001/32; A61B 1/045 20060101 A61B001/045 |
Claims
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 of claim 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 of claim 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 of claim 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 of claim 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 of claim 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 of claim 1, comprising imaging an area using the
imaging device.
8. The method of claim 1, comprising illuminating an area using a
light source of the imaging device.
9. The method of claim 8, comprising imaging the area using the
imaging device.
10. The method of claim 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 of claim 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 of claim 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 of claim 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 of claim 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 of claim 12, comprising providing at least one of
irrigation or suction through the lumen.
17. The method of claim 12, comprising imaging an area using the
imaging device.
18. The method of claim 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 of claim 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 of claim 20, comprising blocking, using a second
seal, air flow through the passageway with insertion of an
instrument into the passageway.
22. The method of claim 20, comprising imaging an area using the
imaging device.
23. The method of claim 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.
Description
CLAIM OF PRIORITY
[0001] This application is a divisional of and claims the benefit
of priority under 35 U.S.C. .sctn. 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. .sctn. 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
[0002] 1. Field of the Invention
[0003] 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.
[0004] 2. Description of the State of the Art
[0005] 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.
[0006] 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.
[0007] 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.
[0008] 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.
[0009] 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.
[0010] 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.
[0011] 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.
[0012] 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.
[0013] 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.
[0014] 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
[0015] 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.
[0016] 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.
[0017] 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.
[0018] 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.
[0019] 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.
[0020] 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.
[0021] 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.
[0022] 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.
[0023] 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.
[0024] 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.
[0025] 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.
[0026] 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.
[0027] 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.
[0028] 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.
[0029] 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.
[0030] 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.
[0031] 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
[0032] 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.
[0033] FIG. 2 is a perspective view of a control box in
communication with the camera.
[0034] 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.
[0035] 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.
[0036] 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.
[0037] 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.
[0038] FIG. 7 is a close-up perspective view of the trocar shaft
showing a sharp point on the distal segment.
[0039] 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.
[0040] 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.
[0041] 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.
[0042] FIG. 11 is a block diagram of circuitry of the camera
capsule.
[0043] FIG. 12 is a block diagram of circuitry of the control
box.
[0044] 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.
[0045] 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.
[0046] 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 of FIG. 8.
[0047] 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.
[0048] 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.
[0049] 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.
[0050] 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
[0051] 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.
[0052] 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.
[0053] 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.
[0054] 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.
[0055] 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 in FIG. 1 a laparoscopic port 10
comprising two main mechanical units: a cannula 12 and a trocar 14.
The laparoscopic port 10 is optionally connected by means of a
cable 80 to a control box 74 shown in FIG. 2. Although the assembly
illustrated in FIG. 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.
[0056] FIG. 3 shows the cannula 12 separated from the trocar 14.
The cannula 12 includes an integrated, embedded camera 16 capable
of providing a view of the portion of the peritoneal cavity that
lies distal to the exit port of the cannula. The cannula 12
includes a single lumen 17, or interior passageway, that provides
access to the abdominal cavity for the insertion of surgical
instruments. A portion of the lumen 17 is defined by an tubular
member or elongate sleeve 18 which contains the camera 16. The
sleeve 18 extends from a cannula handle 20 on a proximal end 22 of
the cannula 12. At the distal end of the sleeve 18, there is an
exit port 23 in the form of a circular opening through which
surgical instruments enter the abdominal cavity of a patient.
[0057] The cannula 12 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.
[0058] Referring now to FIG. 4, the cannula handle 20 includes an
entry port 24 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, a concentric
seal 26 adjacent the entry port 24 is configured to prevent leakage
of gas when an instrument is present within the cannula 12. The
concentric seal 26 can be made from a flexible material such as
rubber.
[0059] As shown in FIG. 5, in the cannula handle 20 there is an
interior seal 28 in the form of a hatch that provides instrument
access to an airtight compartment 30 and the sleeve 18. A hinged
door 32 includes a lip 34. The door 32 is shown in an open position
(illustrated in solid lines) and in a closed position (illustrated
in broken lines). When in the closed position, the door 32 and lip
34 ensures an air tight seal. The interior seal 28 maintains
insufflation pressure within the abdominal cavity when an
instrument is not present in the cannula. The hinged door 32 is
designed to open toward the distal end of the cannula when an
instrument is inserted into the cannula 12 from the entry port 24
at the proximal end 22. The hinged door 32 can be constructed from
plastic, while the lip 34 can be formed from a deformable material
such as rubber.
[0060] Still referring to FIG. 5, on one side of the cannula handle
20 there is an insufflation air port 36. During a laparoscopic
procedure, the air port 36 allows nitrogen, carbon dioxide, or
other gas to be introduced into a patient's abdominal cavity to
achieve and maintain a desired insufflation pressure. A lever 38
controls whether a valve inside the air port 36 is open or
closed.
[0061] FIG. 6 shows the trocar 14 separated from the cannula 12.
The trocar 14 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 the trocar 14 can also be
constructed of a metal. The trocar 14 includes a trocar handle 40
at its proximal end 44. A narrow cylindrical member or shaft 46
extends from the trocar handle 40 to a distal end 48 of the trocar
14. The shaft 46 has a greater diameter 47 along a short distance
49 at the distal end 48. At the very tip of the shaft 46, there may
be a sharp point 50 to facilitate insertion of the trocar and
cannula through the abdominal wall or other anatomical region.
[0062] As illustrated in FIGS. 6 and 7, the point 50 at the very
tip 48 of the trocar shaft 46 may be shaped like a triangle.
[0063] Referring again to FIG. 6, the trocar handle 40 includes two
projection features 52, one on each side. The projection features
52 mate with complimentary grooves 54 (FIG. 5) on the corresponding
sections of a cannula handle 20. Each projection feature 52 is
attached to a depressible button 56 which facilitates release of
the trocar handle 40 from the cannula handle 20.
[0064] As shown in FIG. 8, the camera 16 and one or more light
sources are integrated into an adjustable imaging device or camera
capsule 58 located at a distal portion of a cannula 12. The camera
capsule 58 is shown in a position outside the cannula lumen 17
(illustrated with solid lines) and in a position inside the cannula
lumen 17 (illustrated with broken lines). A trocar 14 is shown
inserted into the cannula 12.
[0065] As shown in FIG. 9, the camera capsule 58 includes the
camera 16 and associated electronics 61. The capsule is created
from two complementary housing components 62, 64 which can be
constructed from a plastic such as polyethylene. The bottom housing
64 exhibits a decline shape or distally facing sloped surface 66,
which allows the retraction of a trocar from a cannula to push the
camera capsule 58 from a position inside the cannula lumen to a
position outside the cannula lumen. A single printed circuit board
(PCB) 67 inside the capsule 58 includes the necessary electronics
for the imaging device. A camera lens 68 and image sensor 70 are
integrated into the top housing 62 of the capsule 58. The lens 68
is mounted such that it overlies the image sensor 70 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.
[0066] Still referring to FIG. 9, in order to provide a light
inside an abdominal cavity or other anatomical cavity of a patient,
light sources 60, such as light emitting diodes (LEDs), are also
integrated into the top component 62 of the capsule 58. The capsule
58 includes a hinge mechanism 72 to attach the capsule 58 to the
distal portion of the cannula 12. This hinge mechanism 72 also
allows the camera capsule 58 to exhibit movement in a single plane
as illustrated in FIG. 8. This swivel mechanism 72 allows the
camera capsule to be tucked inside the lumen 17 of the cannula 12
or to lie just outside of the lumen while the trocar 14 and cannula
12 are being inserted into an anatomical site.
[0067] Preferably, but not necessarily, other electrical components
are found in the camera capsule 58 and the control box 74 (FIG.
2).
[0068] As shown in FIG. 10, electrical wiring from the camera
capsule 58 is carried to the proximal end of the cannula through a
conduit 76 and is interfaced to a connector 78 at the cannula
handle 20. A cable assembly 80 (FIG. 2) routes these electrical
connections to the control box 74 (FIG. 2) through one of the
connectors 82 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 the control
box 74, and the datal/signal line carries the video images to the
control box.
[0069] Referring again to 9, the PCB 57 within the camera capsule
58 includes a power management integrated circuit (IC) 130, a clock
or crystal 132, and a signal processing IC 134.
[0070] In FIG. 11, there is shown a block diagram of circuitry
within the camera capsule 58. Electrical wires 84 (FIG. 9) connect
the PCB 57 to the image sensor 70 and LEDs 60, which are integrated
into the capsule 58. Power to the light sources 60 is routed via
the power management circuit 130 on the camera capsule PCB 57.
Controlling circuitry may be included in this PCB 57 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.
[0071] The image sensor 70 integrated into the top housing 62 of
the capsule 58, as shown in FIG. 9, is an electronic device which
converts light incident on photosensitive semiconductor elements
into electrical signals. The signals from the sensor 70 are
digitized and used to reproduce the image that was incident on the
sensor. Two types of image sensors 70 are Charge Coupled Devices
(CCD) and Complementary Metal Oxide Semiconductor (CMOS) camera
chips.
[0072] The image data captured by the image sensor 70 is then
decoded by the signal processing integrated circuit 86 (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 box 74 (FIG.
2).
[0073] Referring again to FIG. 2, the control box 74 transmits
power and control commands from its internal circuitry to the
camera capsule 58 near the distal end of the cannula 12. The
control box 74 also serves to process and retransmit the video
streams received from the camera capsule 58 to a display device,
such as an LCD display 88 on the control box 74 or a video monitor
connected to video output connectors 90 on the control box.
[0074] The control box 74 comprises of image and signal processing
circuitry in an enclosure with a control panel, LCD display 88, and
connectors. The LCD display 88 in conjunction with the control
panel provides a menu-driven interface. FIG. 2 shows the physical
layout of the control box 74, while FIG. 12 shows a block diagram
of the circuitry of the control box. It will be appreciated that
the control box 74 can be configured in ways other than what is
shown in FIG. 2.
[0075] As shown in FIG. 12, the control box 74 comprises image and
signal processing Ics 136, a crystal or clock 138, input and output
interfaces 140, a power management IC 142, button input switches
144, and a controller CPU 146. After the control box 74 receives
the signal from the camera 16, the controller CPU 146, which
includes a signal processing IC, decodes the signal and is sent to
image processing circuits 136. 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
CPU 146 for output to an external monitor.
[0076] Still referring to FIG. 12, the controller CPU 146 also
interfaces with the image sensor 70 of the camera capsule 58. This
CPU allows users to employ the buttons 92, knobs 94, and a
menu-driven interface of the control box 74 (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.
[0077] The control box 74 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 a single display monitor 96 using a
split-screen or picture-in-picture (PIP), as shown in FIG. 13. A
view of the main endoscope can be shown on the main portion 98 of
the display monitor 96, while additional views from various camera
capsules can be shown as smaller pictures 100 within the main
portion of the display.
[0078] Operation of the system shown in FIGS. 1-13 will now be
described in accordance with an embodiment of the present
invention. The electrical cable 80 between the cannula handle 20
and control box 74 is connected to the appropriate connectors 78,
82. The camera capsule 58 in the distal portion of the cannula 12
is pivoted outward by hand to the outside of the cannula lumen. The
trocar 14 is then slid into the cannula 12 until the trocar handle
40 snaps into the cannula handle 20.
[0079] The camera 16 is then powered on by manipulating controls
found on the control box 74. The camera 16 begins to transmit video
images to the control box 74 through the electrical wires in the
cannula 12. The internal circuitry of the control box 74 decodes
and processes the signal in order to create video signals for
output to an external monitor 96. The images are then displayed on
the external monitor 96.
[0080] Before inserting the cannula 12 and trocar 14 into a
patient, the camera capsule 58 is pivoted inward by hand into the
lumen 17 of the cannula 12 in order to facilitate insertion. The
cannula 12 and trocar 14 are pushed through the abdominal wall or
other anatomical region by taking advantage of the cutting surface
50 on the distal tip of the trocar.
[0081] Once the anatomical region has been entered, the trocar 14
is withdrawn, leaving the cannula 12 in place. The larger diameter
47 of the distal tip of the trocar 14 causes the camera capsule 58
to pivot outward to its outside the lumen position. Under direct
visualization through its camera 16, the cannula 12 is then
carefully advanced to the appropriate depth. The cannula 12 is then
ready to accept instruments through the cannula lumen 17.
[0082] Additional cannulas or access ports having cameras can be
employed and connected to the same control box 74. Through the use
of buttons on the control box 74, the user can vary brightness and
other settings. The user can also obtain still images by pressing
various buttons on the control box 74. 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.
[0083] 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, a trocar
14 has a distal tip 48 with three projections 102 made from plastic
or metal, as shown in FIG. 14. The projections 102 are spaced
equally around a center point on the distal tip 48 of the trocar
14.
[0084] 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 in FIGS. 1, 3, 4, 8, and 10. The
hinge connector, which attaches the capsule to the cannula, can
also be varied in order to provide a range of pivot angles.
[0085] In FIG. 15 there is shown an embodiment in accordance with
the present invention in which a blunt tip trocar 14 is used to
keep a camera capsule 58 in its "outside lumen position" even when
there is no surgical instrument inserted through the access port
sleeve 18. Instead of the narrow shaft 46 of FIG. 8, which allows
the camera capsule 58 to lie in its "inside lumen position" during
insertion of the cannula 12 and trocar 14 through an abdominal
wall, the shaft 46 of FIG. 15 has an outside diameter 104 that is
only slightly smaller than the inside diameter 106 of the access
port sleeve 18. Therefore, the trocar of FIG. 15 exerts pressure on
the bottom housing 64 of the camera capsule 58, 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. The shaft 46 could have this
larger diameter 104 throughout its full length, or only in that
portion of the shaft where it would be required in order to exert
pressure on the camera capsule 58 to maintain the camera capsule in
its outside lumen position. The handle of the blunt tip trocar of
FIG. 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.
[0086] 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.
[0087] 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.
[0088] In FIG. 16, there is shown an embodiment of the present
invention in which an access port 12 employs multiple camera
capsules 58 with imaging lenses 68 that are oriented such that they
can provide additional viewpoints. For example, one imaging lens
68A can be oriented longitudinally while other lens 68B can be
oriented at a right angle to the longitudinal axis 108 of access
port 12. 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 access port 12. The
two camera capsules 58 can be pivoted independently of one another
to adjust its angle of view through an externally-controlled
mechanism 110 without requiring movement of the entire access port
12.
[0089] Referring now to FIG. 17, a camera capsule 58, which
includes a camera 16 and light sources 60, is integrated into a
cannula sleeve 18 having a small additional lumen 112 that houses
the camera capsule and associated wires. The camera 16 and the
light sources 60 are located on a distal edge 116 surrounding an
exit port 23 of a cannula 12. The cylindrical component of the
cannula 12 that houses the main instrument lumen 17 and the
additional lumen 112 could be created by extruding a material such
as polyethylene. In this embodiment, the camera 16 would be fixed
in position, while the main lumen 17 would allow the passage of
surgical instruments. Furthermore, this embodiment would allow
visualization during insertion of the cannula 12 and trocar in
order to prevent any accidental damage to tissue or organs.
[0090] FIG. 18 depicts an embodiment in which a non-adjustable
camera capsule 58 lies, along with its electrical wires, in a lumen
or tube 114 that is external to the sheath 18 of a cannula 12. The
camera capsule 58, which includes a camera 16 and two light sources
60, is adjacent a distal edge 116 surrounding an exit port 23 of
the cannula 12. The tube 114 can be bonded to the outside surface
of the cannula sheath 18 or simultaneously created with the sheath
18 by extruding a material such as polyethylene.
[0091] 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.
[0092] 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.
[0093] FIG. 19 depicts an embodiment of the present invention in
which a trocar 14, which is adapted to pass through a cannula,
contains a light source 60, such as one or more LEDs or fiber optic
bundles, as well as a sensor 70 with associated electrical wiring
to transmit an image to a video processing system. The trocar 14 of
FIG. 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.
[0094] 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.
[0095] 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.
[0096] 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.
[0097] 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.
[0098] 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.
[0099] 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.
[0100] Referring again to FIGS. 1 and 3, an endoscopic port
assembly 10 is shown in accordance with an embodiment of the
present invention. The endoscopic port assembly 10 can be used in a
variety of endoscopic procedures. The endoscopic port assembly 10
comprises an endoscopic port 12, a trocar 14, and an imaging device
16. The port 12 includes a lumen 17. The trocar 14 is sized to be
insertable into the lumen 17. The imaging device 16 is disposed on
the port 12. The imaging device 16 may optionally be disposed on
the trocar 14.
[0101] Referring next to FIG. 8, the port 12 of the endoscopic port
assembly 10 may include a cannula or tubular member 18 to which the
imaging device 16, 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 axis 118 of the tubular member 18, such as
shown by directional arrow 120. Radially outward refers to a
direction away from the central axis 118, such as shown by
directional arrow 122.
[0102] Referring again to FIGS. 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 a laparoscopic port 12 that includes
an integrated imaging device 16. The port 12 preferably includes a
cannula or tubular sheath 18 to which the imaging device 16 is
mounted. The imaging device 16 is mounted such that an imaging lens
of the imaging device is movable between a position outside the
cannula 18 and a position inside the cannula. Optionally, the
imaging device 16 is mounted such that the imaging lens is disposed
at a distal edge 116 of the cannula 18.
[0103] Referring once again to FIGS. 5 and 8, an endoscopic port
assembly 12 is shown in accordance with an embodiment of the
present invention. The assembly 12 comprises an endoscopic port 12
and an imaging device 58. The port 12 includes a proximal end 22
and a distal end. An instrument passageway 17 extends from the
proximal and distal ends. A first seal 28 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. The first seal 28 is
adapted to move to the open position when an instrument 14 is
inserted into the passageway 17. The first seal 28 is further
adapted to move to the closed position when the instrument 14 is
subsequently removed from the passageway 17. The port 12 also
includes a second seal 26 that is adapted to block air flow through
the passageway 17 when the instrument 14 is inserted into the
passageway.
[0104] 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.
* * * * *