WO2013135354A2

WO2013135354A2 - Trocar system

Info

Publication number: WO2013135354A2
Application number: PCT/EP2013/000657
Authority: WO
Inventors: Siegfried Riek; Karl-Heinz Bachmann; Thomas Gaiselmann
Original assignee: Siegfried Riek; Karl-Heinz Bachmann; Thomas Gaiselmann
Priority date: 2012-03-13
Filing date: 2013-03-06
Publication date: 2013-09-19
Also published as: DE102012203907B4; DE102012203907A1; WO2013135354A3

Abstract

The invention relates to a trocar system comprising a trocar (10) and a trocar sleeve (16), wherein in the trocar sleeve (16) at least one work channel (22) leads continuously from a proximal inlet opening (24) to a distal outlet opening (26).

Description

Trocar System The invention relates to a trocar system according to the preamble of patent claim 1.

Trocar systems for minimally invasive surgery usually consist of a trocar to create an opening in a body cavity (eg abdominal cavity) and a trocar sleeve which remains in this opening and access to the interior of the body cavity forms the operative procedure. The trocar has a distal tip which is used to penetrate the body tissue, e.g. B. the abdominal wall is used. The distal tip of the trocar may be formed sharp, cutting or blunt. For example, a sharp point has the shape of a triangular pyramid. Cutting tips have a blade which creates a tissue incision which is subsequently delated by the conical tip. Blunt tips are distally rounded so that they essentially only dilate a previously created lesion. In order to prevent that in the penetration of the abdominal wall by adhesions on the peritoneum adhering internal organs, eg. B. intestine or blood vessels in the abdominal wall or in the retroperitoneum are injured, so-called optical trocars are known, as described for example in US 5,685,820 A. In these optical trocars, the distal tip of the trocar is formed as a hollow transparent cone which is observable from the inside by an optic which is received in a coaxially extending in the Trokardorn optical channel.

In minimally invasive surgery, the single-port surgical technique is increasingly being used. In this surgical procedure

CONFIRMATION COPY nik are introduced by a single access (single-port) required for surgical intervention instruments and also required for illuminating and observing the intracorporeal surgical ^¬ field optics. As a rule, a relatively large access incision is required in order to allow maneuvering of the inserted instruments and to have space for insertion of the optics. From the

US 2011/0201883 AI it is known to use as a single-port access a trocar sleeve in an incision. In this trocar sleeve an instrument guide is used, which has from working from proximal to distal through working channels. The working channels are formed as axially continuous grooves in the lateral surface of the guide and are closed on the outside by the trocar sleeve. Also in this single-port system, a relatively large diameter of the trocar sleeve is required to accommodate the guide with the working channels for the instruments and for the optics. The trocar sleeve is inserted by means of a trocar dart, whereupon the trocar dart is withdrawn and replaced with the guide.

The invention has for its object to provide a trocar system for the single-port surgical technique, which makes only a small incision required and is easier to use.

This object is achieved by a trocar with the features of claim 1.

Advantageous embodiments of the invention are specified in the subclaims.

The trocar system according to the invention has a trocar dart and a trocar sleeve. To have access for an intracorporeal To create an operative field, the trocar is inserted via an incision, wherein the distal tip of the trocar mandible is used for pene- trating and dilating the tissue. The trocar may be a conventional massive trocar, z. B. with sharp, cutting or blunt tip. The trocar mandrel is used to insert the trocar sleeve into the generated body opening. The wall of the trocar sleeve has at least one working channel, which leads continuously from a proximal inlet opening to a distal outlet opening. Through these working channels, the instruments required for the minimally invasive surgery can be guided to the surgical field. The trocar sleeve thus serves as a single-port access for the surgical procedure. Once the trocar sleeve is inserted by means of the trocar, the trocar can be removed and replaced with an optic. The optics make it possible to perform the operation with the instruments introduced through the working channels under view.

Since the working channels are formed in the trocar sleeve and the optic can be inserted coaxially into this trocar sleeve, the trocar system can be made with a relatively small diameter, so that only a small incision is required for the single-port system. It is also advantageous in particular that conventional designs of the trocar arbor and the optics can be used.

The instruments which can be used with the trocar system according to the invention are essentially miniature surgical instruments known per se. These have a retractable at the distal tip of the trocar _. Working on, while at the proximal outside of the working channel remaining end of the proximal actuators of the miniature instrument are arranged. The instruments can be equipped with a rigid or be formed flexible or semi-flexible shaft. In semiflexible instruments, it is possible to bias them so elastically that their distal working elements bend on exiting the distal outlet opening of the trocar sleeve against the central axis of the trocar sleeve to operati ^¬ ven engagement immediately before the distal end of the trocar and thus directly before the optics inserted in the trocar sleeve. Alternatively, in the working channel and a guide tube may be arranged to be axially displaceable and rotatable, through which the miniature instrument is performed. The guide tube is superiors in its distal end elastically to bending ^■ clamped. Preferably, the guide tube consists of a memory alloy with superelastic properties, eg. From nitinol. When the guide tube is pushed distally out of the working channel, its distal end curves out of its longitudinal axis defined by the working channel, the deflection angle increasing with respect to the longitudinal axis as the distal end of the guide tube emerges from the working channel. By rotating the guide tube in the working channel while the direction of the deflection can be rotated about the longitudinal axis. By axial displacement and rotation of the guide tube thus the exit direction and positioning tion of the distal working element of the miniature instrument can be controlled three-dimensionally. Adjusting means provided at the proximal end permit the axial and rotational movement of the guide tube in the working channel. The miniature instruments may be, for example, tweezers, forceps, scissors, blades, clamps, coagulation instruments, or the like. Likewise, it is possible to introduce a Veressnadel over a working channel to view under the Pierce peritoneum and insufflate the abdomen. Further, it is possible to introduce through a working channel a miniatu ^¬ risierte digital camera and fiber optic lighting systems and optics. This allows a penetration of the tissue under view, even if a massive trocar is verwen ^¬ det.

In order to prevent escape of the gas from the exhausted abdominal cavity through the working channels, the working channels may be closable proximally by a valve when no instrument is in the working channel. Such a valve may in particular be formed by a lip seal known per se, which allows a passage of an instrument and seals an inserted instrument on its outer periphery.

Further unused working channels can be closed by a stylet that closes the distal outlet opening of the working channel, so that in particular contamination of the working channel is avoided. This may be advantageous in particular when inserting the trocar sleeve by means of the trocar mandrel.

The working in the trocar sleeve from proximal to distal working channels can be made in different ways.

In one embodiment, the at least one working channel is formed as an axially continuous bore in the wall of the trocar sleeve. This design is complex manufacturing technology. However, the closed at their entire circumference working channels have the advantage that these working channels are also available for the insertion of instruments when is neither a trocar another look into the trocar sleeve inserted ^¬ sets. The inner volume of the trocar sleeve can then also be used for the surgical procedure. Manufacturing technology is easier if the at least one working channel as a groove, in particular as an axially extending groove in the inner wall surface of the wall of the trocar sleeve is ^{¬ out} forms. The open towards the interior of the trocar sleeve groove is completed by the trocar or through the used instead of trocar horn optics to form a closed round working channel for the insertion of the instruments.

Finally, it is also possible, the at least one working channel by an outside on the lateral surface of the wall of the

Trocar sleeve attached tube to form. This is herstel ^¬ development particularly easy, but increases the outer diameter of the trocar slightly. The working channels are generally parallel to the axis of the trocar sleeve, but can also extend at an angle to the instrument axis or helically around the instrument axis. In the proximal inlet region and / or in the distal outlet region, the working channels can also extend angled outwards from the axially parallel direction. Outwardly angled entry of the working channels facilitates insertion of the instruments and actuation of the proximal actuators of the instruments. An outwardly angled course in the distal exit area of the working channels may favor the positioning and navigation of the distal working elements of the instruments. Preferably, an axially continuous bore can be arranged as an insufflation channel in the wall of the trocar sleeve. This provides an easy way to perform an insufflation during the surgical procedure, which is particularly advantageous in the single-port surgical technique. Of course, the insufflation can also be done by the inner volume of the trocar, as is common in known trocar systems. On the trocar sleeve can usually be mounted in a conventional manner, a valve housing which closes the trocar proximal when no trocar, no optics or any other instrument is inserted into the trocar. When the trocar, optic or surgical instrument is inserted through the trocar sleeve, it is sealed at its periphery to prevent leakage of the insufflation gas. The proximal inlet end of the working channels are located outside of the valve housing so that the jewei ^¬ time instruments may be inserted independently of the valve housing in the working channels.

In the following the invention will be explained in more detail with reference to embodiments shown in the drawing. Show it :

1 shows an axial section through the trocar system in a first embodiment,

Figure 2 shows a cross section of this trocar according to the

Section line A - A in Figure 1,

FIG. 3 shows a corresponding cross section of the trocar system in a second embodiment, FIG. 4 shows a corresponding cross-section of the trocar system in a third embodiment, and FIG. 5 shows an axial section of the trocar system in FIG

Trocar sleeve inserted optics.

In the drawing and in the following description, only the parts of the trocar system are shown, which are formed erfindungsge accordance. Incidentally, the trocar system corresponds to the known prior art, with all known from the prior art modifications should be included.

The trocar system has a trocar 10. The trocar mandrel 10 is in the form of a rigid elongated cylindrical shaft which is solidly made of metal or plastic. The distal tip 14 of the trocar 10 has z. B. the shape of a cone with rounded blunt tip or a pyramid with cutting edges. If appropriate, the tip 14 can also be convexly bulged.

On the trocar 10, a hollow cylindrical trocar 16 can be postponed. The inner diameter of the trocar sleeve 16 corresponds substantially to the outer diameter of the trocar 10. At the proximal end of the trocar 16 is arranged in a known per se and therefore not further explained manner, a valve which closes the trocar sleeve 16 sealing when in the trocar 16th no instrument is located. If the trocar 10, an optic 28 or other instrument introduced through the trocar 16, so they are sealed at its periphery by the valve. In the trocar sleeve 16, an insufflation channel 18 may be formed. The insufflation channel 18 extends as an axially parallel bore in the wall of the trocar sleeve 16. At the proximal end of the insufflation channel 18 there is a connection 20 for the insufflation gas. Distally, the insufflation channel 18 opens open at the distal end of the trocar sleeve 16. Alternatively, the connector 20 can also lead into the inner lumen of the trocar sleeve 16, so that the inner lumen forms the insufflation channel.

If the trocar sleeve 16 is pushed onto the trocar mandrel 10, then the distal end of the trocar sleeve 16 adjoins the proximal end of the tip 14 of the trocar mandrel 10, so that the outer contour of the tip 14 smoothly merges into the outer circumference of the trocar sleeve 16.

The trocar system has at least one working channel 22, which extends in the trocar sleeve 16 from proximal to distal. The working channel 22 extends generally axially parallel to the central axis of the trocar sleeve 16. At the proximal end, the working channel 22 has an inlet opening 24, which is outside ^¬ half of the valve, so that it is freely accessible. The inlet opening 24 may be angled against the axis-parallel direction. At the distal end of the working channel 22 opens into a free outlet opening 26 in the region of the distal end of the trocar sleeve 16. Also, the axial direction of the outlet opening 26 may be angled against the axis-parallel direction. In the illustrated embodiments, two working channels 22 are arranged diametrically opposite each other. However, it is also possible that only one working channel 22 or more than two working channels 22 are provided. Are two or more working channels 22 provided so they are preferably arranged at the same mutual angular distance.

The working channels 22 are used for introducing per se known miniature instruments. These miniature instruments are be ^¬ likige, the respective application corresponding instruments., As they are known per se. The miniature instruments comprise an elongate rigid, flexible or semi-flexible shaft, in each case a working beitselement disposed at its distal end which may be actuated by means of a arranged at the proximal end of the shaft ^■ actuator. The miniature instrument is inserted into the working channel 22 at the proximal end, where it can be sealed at the proximal inlet opening 24. An outwardly angled course of the inlet opening 24 facilitates the insertion of the miniature instrument laterally in front of the valve of the trocar 16. The miniature instrument is advanced in the working channel 22 until the distal working element is extended through the outlet opening 26 and used in front of the distal tip 14 can. Are the

Trocar 16 and the working channels 22 made of a durchsichti ^¬ gene plastic, so the insertion and advancement of the miniature instrument can be observed from the outside. If required, a stylet, not shown in the drawing, can be inserted into an unused working channel 22, which with its distal end closes the outlet opening 26 flush, so that the ingress of contaminants into the unused working channel 22 is prevented.

The at least one working channel 22 can be manufactured in different ways. In a first embodiment shown in Figures 1 and 2, the at least one working channel 22 is formed as an axially continuous bore in the solid wall of the trocar sleeve 16. This embodiment is particularly suitable when the trocar 10 is replaced by an optic 28 after insertion of the trocar sleeve 16.

In a second exemplary embodiment shown in FIG. 3, the at least one working channel 22 is formed by an axially continuous groove which is formed in the inner wall surface of the wall of the trocar sleeve 16. The region of the groove which is open on the inside of the trocar sleeve 16 is closed by the outer lateral surface of the trocar mandrel 10 or by the outer lateral surface of the optic 28 inserted into the trocar sleeve 16 in order to form the working channel 22 closed over its entire cross-sectional circumference.

In a third embodiment shown in Figure 4, the at least one working channel 22 is formed by a tube which is externally attached to the outer circumferential surface of the wall of the trocar sleeve 16, for. B. glued, dotted or poured into the lateral surface.

The trocar consisting of the trocar 10 and the trocar 16 is inserted into the patient's body, e.g. B. used in the abdominal wall. For this purpose, the trocar is pierced over a skin incision, wherein the trocar 10 penetrates the tissue with its tip 14 and widens the tissue opening produced thereby. Once the tip 14 has entered the body cavity, the trocar 10 is withdrawn from the trocar sleeve 16 and the trocar sleeve 16 remains as a single-port access in the generated body opening. Instead of the trocar 10, the optic 28 is now inserted into the trocar sleeve 16. puts. The optic 28 is essentially a per se known optics containing an imaging system and illumination means. When inserted optics 28 is the distal end 30 at the distal end of the trocar sleeve 16. By means of the optics 28, the intracorporeal surgical field can be illuminated and observed. By means of the working channels 22 introduced ^¬ instruments, the surgical intervention in front of the optics 28 can be performed under view.

LIST OF REFERENCE NUMBERS

10 trocar horn

14 tip

16 trocar sleeve

18 insufflation channel

20 connection

22 working channel

24 entrance opening

26 outlet opening

28 optics

30 distal end

Claims

claims

1. trocar system with a massive trocar (10) and with a trocar sleeve (16),

That is, the wall of the trocar sleeve (16) has at least one working channel (22) which leads continuously from a proximal inlet opening (24) to a distal outlet opening (26).

2. Trocar system according to claim 1,

That is, the at least one working channel (22) is formed as a bore extending from proximal to distal in the wall of the trocar sleeve (16).

3. trocar system according to claim 1,

characterized in that the at least one working channel (22) is formed as a groove in the inner wall ^¬ surface of the trocar sleeve (16).

4. Trocar system according to claim 1,

That is, at least one working channel (22) is formed by a tube attached to the outer lateral surface of the trocar sleeve (16).

5. Trocar system according to one of the preceding claims,

That is, an axially continuous bore is formed in the wall of the trocar sleeve (16) as an insufflation channel (18) for introducing a gas for insufflation.

A trocar according to any one of the preceding claims, characterized in that on the trocar sleeve (16) is disposed proximal a valve wel ^¬ ches a sealed passage of the trocar mandrel (10) or an optical system (28) allows and the trocar sleeve (16) closes when the Trocar (10) or the optic (28) is not inserted, and that the proximal inlet opening (24) of the at least one working channel (22) is outside the valve.

A trocar according to any one of the preceding claims, characterized in that Wenig ^¬ least a miniature instrument through the at least one working channel (22) is insertable in such a manner that a distal working element of the miniature instrument emerges distally from the outlet opening (26) of the working channel (22) and a proximal actuating element of the miniature instrument is located proximally outside the inlet opening (24) of the working channel (22).

Trocar system according to claim 7,

That is, the miniature instrument is a pair of scissors, a knife, a pair of tweezers, a clamp, a coagulation instrument, a Veressnadel, a digital camera, a light guide, a lighting system or an optic.

9. Trocar system according to one of the preceding claims,

characterized in that the trocar sleeve (16) forms a single-port access.

10. Trocar system according to claims 7 or 8 and 9, characterized in that after pulling out the trocar (10) an optic (28) in the trocar sleeve (16) can be inserted, by means of which the distal working element of at least one miniature ^¬ instrument is observable ,

11. Trocar system according to one of the preceding claims,

characterized in that in the at least one working channel (22), a guide tube is axially displaceable and rotatably disposed, through wel ^¬ ches the miniature instrument is guided, and that the guide tube is elastically biased at least in its distal end portion to curvature.

Trocar system according to claim 11,

The guide tubes are made from a memory material with superelastic properties, eg. Nitinol exists.