The present invention relates generally to cannulas with integrated imaging and illumination devices, more particularly to those configured with a deployable portion.
In minimally invasive surgery, there are often several small incisions made into the body to insert surgical tools, insufflation devices, endoscopes, or other viewing devices. Surgeons are now doing procedures in a manner that minimizes the number of incisions, possibly to only one, referred to as Single Port Incision or Single Port Access (SPA). Surgeons are also using natural orifices, such as the mouth, to provide access for procedures using no incision or only incisions internal to the body.
The advantages sought by surgeons by reducing the number of incision points to as few as possible is to lessen trauma to the patient, reduce the incidence of infection, improve recovery time, and decrease cosmetic damage.
The reduction of incision locations will change the way that surgeons and their teams work. There may no longer be room around the access point to accommodate multiple surgeons who would normally hold and adjust instruments around the surgical field. A single surgeon may need to control all of the instruments for the procedure through one access point.
For example, endoscopic surgical procedures performed through a tubular cannula have evolved over the years. Presently, surgeons are performing endoscopic procedures in any hollow viscus of the torso body area after the region is insufflated. Typically, multiple narrow cannulas are each inserted through individual small entrance wounds (i.e., ports) in the skin, in order to accommodate various instruments, as well as varying viewing angles. To accomplish their insertion, separate trocars are used in conjunction with the cannulas to puncture the body cavity. A trocar is a guide placed inside the cannula with either a pointed cutting blade or blunt tip, depending on whether it is used to puncture the skin or enter through a separately made incision. Once the cannula is inserted, the trocar is removed, leaving the hollow cannula in place for use during the procedure.
The entry and deployment of imaging and/or lighting components can aid surgical procedures, such as endoscopic procedures. Examples of tubular cannula with deployable imaging and/or lighting components are described in U.S. Pat. No. 5,166,787 to Irion, U.S. Application Publication No. 2009/0275799 to Saadat et al., U.S. Application Publication No. 2009/0259097 to Thompson, and U.S. Application Publication. No. 2008/0065099 to Cooper et al., the disclosures of all of which are herein incorporated by reference in their entireties.
There is, therefore, a need in the art for a surgical apparatus assembly combining trocar cannula, with imaging and illumination capabilities, in order to minimize the number of openings in the body per procedure.
Prior art surgical instruments lack the ability to protect the optics of both imagers and illumination during insertion and lack the ability to obtain a viewing angle that is offset from the cannula axis. One purpose of the present invention is to make it easier to control the access, imaging, and instrument use during minimally invasive surgery, when using fewer incisions than typically necessary. By combining the cannula, imaging, and illumination, a single device can take the place of several, thereby allowing more efficient and more easily controlled access.
In one embodiment of the invention, a surgical apparatus includes combinations of trocar, cannula, and imaging and illumination components. In this embodiment, such combinations provide the surgeon with improved viewing of the surgical cavity. Alternative embodiments allow for reduced number of incisions on a patient.
The apparatus also allows for the development of improved surgical methods including reduced number of incisions, improved imaging of the surgical cavity, and/or improved performance of surgical effectiveness.
In one aspect, the invention relates to a cannula having a tubular element forming a lumen, such that the tubular element has a proximal end and a distal end adapted to be inserted into a body cavity. The cannula assembly includes a deployable portion of the tubular element, engaged near the distal end of the tubular element so as to transition between a closed position and an open position. The cannula assembly includes an electronic component mounted to the deployable portion of the tubular element, such that the electronic component is at least partially disposed in the lumen when the deployable portion is in the closed position.
In an embodiment of the foregoing aspect, the open position includes a range of positions. In another embodiment, the electronic component is disposed remotely from the lumen when the deployable portion is in the open position. In yet another embodiment, the deployable portion includes a wall portion of the tubular element. In still another embodiment, the cannula assembly also includes a removable trocar adapted to fit into the lumen when the deployable portion is in the closed position. In an embodiment, the deployable portion forms a pointed tip at the distal end of the tubular element when the deployable portion is in the closed position. In another embodiment, the pointed tip includes an optically transparent material, so as to project an image through the pointed tip onto the electronic component when the deployable portion is in the closed position.
In yet another embodiment of the above aspect, the electronic component can be an image transmission component, an illumination component, and combinations thereof. In still another embodiment, the image transmission component can be a charge-coupled device camera, a complementary metal oxide semiconductor imaging device, and a fiber optic cable. In an embodiment, the illumination component can be a light source and a fiber optic cable. In another embodiment, the light source can be a light emitting diode, an organic light emitting diode, a filament lamp, an electroluminescent source, and a laser source.
In still another embodiment of the above aspect, the deployable portion of the tubular element transitions between the open position and the closed position via a hinge arrangement. In an embodiment, the hinge arrangement is disposed in the tubular element. In another embodiment, the hinge arrangement includes a pivot. In yet another embodiment, the hinge arrangement is disposed on a circumference of the tubular element. In still another embodiment, the hinge arrangement includes a circumferential hinge. In an embodiment, the hinge arrangement is disposed on an exterior of the tubular element. In another embodiment, the hinge arrangement includes at least one four-bar linkage.
In yet another embodiment of the foregoing aspect, the cannula assembly also includes an actuation mechanism configured to transition the deployable portion between the closed position and the open position. In another embodiment, the actuation mechanism includes a knob disposed near the proximal end, at least one link coupled to the knob, and a hinge arrangement coupled to the at least one link and the deployable portion, such that rotation of the knob moves the deployable portion between the open position and the closed position.
In another aspect, the invention relates to a method of using a cannula assembly including inserting a tubular element with a lumen into a body cavity, such that the tubular element has a proximal end and a distal end, and actuating a deployable portion of the tubular element about the distal end from a closed position to an open position, such that an electronic component mounted to the deployable portion is at least partially disposed in the lumen when the deployable portion is in the closed portion and the lumen is substantially free from obstruction when the deployable portion is in the open position.
In an embodiment of the foregoing aspect, the method of using a cannula assembly also includes using the electronic component to view a portion of the body cavity beyond the distal end. In another embodiment, the method also includes passing at least one of a surgical tool and a second electronic component through the lumen beyond the distal end when the deployable portion is in the open position. In yet another embodiment, the method of using a cannula assembly also includes first introducing an insertion cannula into the body cavity such that the tubular element is inserted through the insertion cannula. In an embodiment, the method also includes withdrawing the cannula assembly from the body cavity through the insertion cannula such that a force exerted on the cannula assembly by the insertion cannula moves the deployable portion to the closed position.
Other features and advantages of the present invention, as well as the invention itself, can be more fully understood from the following description of the various embodiments, when read together with the accompanying drawings, in which:
To provide an overall understanding of the invention, certain illustrative embodiments will now be described, including apparatus and methods for displaying images. However, it will be understood by one of ordinary skill in the art that the systems and methods described herein may be adapted and modified as is appropriate for the application being addressed and that the systems and methods described herein may be employed in other suitable applications. All such adaptations and modifications are to be considered within the scope of the invention.
All or parts of the distal end of the cannula assembly 100 are capable of being positioned into a closed position 102 for insertion and extraction either directly into the body cavity or through another insufflating cannula. When closed, the distal end assembly forms a pointed tip, such as a trocar capable of puncturing the patient's skin. In another embodiment, the lumen 202 of the tubular element 110 is can be fitted with a retractable and/or removable trocar, such as that depicted in
One or more portions of the distal end 116 of the tubular element 110 may be designed to open once inserted into the body cavity. In one embodiment, as depicted in
The electronics components include one or more image transmission components 304, in combination with one or more illumination components 305. In one embodiment, the image transmission component 304 may be a charge-coupled device (CCD) camera, a complementary metal oxide semiconductor (CMOS) imaging device, and/or an imaging fiber optic cable, and their ancillary optics and electronic drivers for power, communication and other functions.
Optically, one or more of the image transmission components 304 may also image across the spectrum, including those portions invisible to the human eye, such as infrared and ultra-violet. In one embodiment, two image transmission components may be configured to capture stereoscopic images (in still and/or in motion). In one embodiment, one or more of the image transmission components 304 may be configured with any of a combination of fixed optics, adaptive optics, and/or active optics. Adaptive and active optics can be capable of focusing and/or zooming onto the image or target area.
In one embodiment, the one or more image transmission components 304 are capable of capturing both motion and still images, and transmitting them to the surgeon or operator through wired or wireless communication means 118 housed within or connected to the housing 108, handle 104, lumen 202 and/or the tubular element 110 wall. Such communications means 118 may include electrical signals, such as analog and/or digital, or a fiber optic communication system.
The illumination component 305 may be one or more light or illumination sources 306, 308, and their ancillary electronic drivers 310. In one embodiment, the illumination sources 306, 308 are Light Emitting Diodes (LED), organic LED (OLED), illumination fiber optic, filament lamps, electroluminescent and/or laser sources. In one embodiment, the illumination component 305 is tailored to work closely in both optical and spectrum characteristics with the image transmission component 304, with the illumination area, level, and homogeneity being optimized. In one example, this may mean the illumination level is controlled by the surgeon or clinician; whereas, in another the image transmission component Automated Gain Control (AGC) is correlated with the illumination level of the illumination component 305.
In one embodiment, as depicted in
The hinge arrangements for the opening/closing of the deployable portions 204 may be accomplished in a number of ways. In one embodiment, one or more of the deployable portions 204 transition between a closed and a number of open positions via a hinge arrangement. The hinge arrangement may include a hinge disposed within a wall of the tubular element 110, e.g., all or partially within the lumen 202, around a pivot point, on a circumference of the tubular element 110, e.g., a circumferential hinge, and/or on an exterior of the tubular element 110. Alternatively, the hinge arrangement may include at least one four-bar linkage.
In an alternative embodiment, the lumen 202 is kept clear by passing the links 704, 706 through a recess along or an aperture formed inside the tubular element 110 wall. In an alternative embodiment, the adjustment means 106 include electro-mechanical actuation of switches, operated by the surgeon or clinician, that drive one or more motors. The motors or actuators may be located either within the proximal end 114 (e.g., non-deployable portions) of the tubular element 110, or within the deployable portion 204. Alternatively, the deployable portion 204 can be moved via a pneumatic or fluidic actuator.
In an alternative embodiment, the hinge connecting the deployable portion 204 to the distal end 116 can include Shape Memory Alloy (SMA) materials with or without an assisted heating element. In one embodiment, using a material such as Nitinol (located within the lumen 202, tubular element 110 and/or the deployable portion 204), any deployable portion 204 can be closed at room temperature (e.g., 25° C.), and deploy at the temperature less than that expected within the body cavity (e.g., less than 37° C.). In an alternative embodiment, the assisted heating element can be controlled by the surgeon or clinician. The voltage for the assisted heating element can be transmitted along the tubular element 110 walls. The assisted heating element is used to place the SMA material into the deployable temperature range once within the body cavity; for example, increasing the voltage will increase the temperature of the SMA material, which transitions the deployable portion 204 to one or more of its open positions. Removing or decreasing the voltage (and hence the heat), makes the deployable portion 204 transition to its closed position.
In one embodiment, as depicted in
In an alternative embodiment, as depicted in
In an alternative embodiment, as depicted in
In one embodiment, the deployable portion 204 containing electronic component is actuated with mechanical links, while the other deployable portion 314, with no electronic component, uses SMA means for deployment. This would allow the fine pointing/triangulation for the deployable portion 204 with electronic components, and a simpler, less precise adjustment mechanism for the other deployable portion 314. In another embodiment, a complementary set of electronics is housed in each deployable portion 204, 314, providing system redundancy selectable by the surgeon or operator. In another embodiment, the tubular element 110 can include three deployable portions, one containing image transmission components, the other containing illumination components, and the last one having no electronic component. Alternatively, at least one or more of an image transmission component and an illumination component can be disposed on each of the deployable portions.
The deployable portion(s) 204 of the tubular element 110 is configured to move from the closed position aligned with the tubular element 110 (i.e., at zero degrees) into an infinite number of open positions from zero to 180 degrees relative to the centerline axis defined by the tubular element 110. This provides the surgeon or operator with the ability to effectively “triangulate” one or more of the field of views of the image transmission component and the illumination component. As may be seen in
A fail-safe design feature of the cannula assembly results from the hinge arrangement for the deployable portion(s) 204 being located at a point upstream of the distal end 116. The deployable portion 204 can be closed upon extraction of the cannula assembly through the force exerted on it during withdrawal through an external insertion cannula 200. In this configuration, the deployable portion 204 is moved to the closed position without operation of the adjustment means 106.
All or part of the distal end 116 of the tubular element 110 may be formed from an optically transparent material as a trocar, pointed tip, or any suitably shaped frontal form. In combination with a deployable or removable mirror occupying all or part of the interior volume of the lumen 202, the surgeon or operator would be able to see a forward view beyond the cannula assembly when the deployable portion 204 is at or near the closed position. In an alternative embodiment, a prism can be used in lieu of a mirror.
Within the lumen, a mirror assembly, which can be one or more suitably reflective surfaces 506, can be placed at suitable angle(s) to permit the forward view. The reflective surface 506 forms a connection 504 (e.g., a rod) through the lumen 202 of the cannula assembly 100 to the proximal end 114, allowing the mirror assembly to be extracted once the deployable portion 204 is opened, if necessary.
As depicted in
In one embodiment, additional illumination sources are placed within indentations in the external surface 904 facing the distal end. Such illumination sources would minimize reflections from the optically transmissive portions of the trocar coming back to the image transmission components. In an alternative embodiment, power for the illumination sources is provided by energy storage components placed within the cannula assembly, e.g., a battery in the handle, minimizing the interfacing to the rest of the cannula assembly. The surgeon can activate the illumination sources at the time of insertion of the cannula assembly. The illumination source may include any of the illumination sources described above. The energy storage component may be batteries or super-capacitors. The energy storage component can be attached to the rod 504 or can be connected to the illumination sources.
Various embodiments and features of the present invention have been described in detail with a certain degree of particularity. The utilities thereof can be appreciated by those skilled in the art. It should be emphasized that the above-described embodiments of the present invention merely describe possible examples of the implementations to set forth a clear understanding of the principles of the invention, and that numerous changes, variations, and modifications can be made to the embodiments described herein without departing from the spirit and scope of principles of the invention. Also, such variations and modifications are intended to be included herein within the scope of the present invention, as set forth in the appended claims. The scope of the present invention is defined by the appended claims, rather than the forgoing description of embodiments. Accordingly, what is desired to be secured by Letters Patent is the invention as defined and differentiated in the following claims, and all equivalents
This application claims priority to co-pending U.S. provisional patent application Ser. No. 61/164,215, titled “Cannula with embedded camera and illumination,” filed on Mar. 27, 2009, and U.S. provisional patent application Ser. No. 61/261,910, titled “Shape Memory Alloy Group, applications including SMA Clips, closures and Endoscope steering,” filed on Nov. 17, 2009, the disclosures of both of which are herein incorporated by reference in their entireties.
Number | Name | Date | Kind |
---|---|---|---|
4858001 | Milbank et al. | Aug 1989 | A |
5166787 | Irion | Nov 1992 | A |
5167221 | Chikama | Dec 1992 | A |
5183471 | Wilk | Feb 1993 | A |
5256149 | Banik et al. | Oct 1993 | A |
5305121 | Moll | Apr 1994 | A |
5381784 | Adair | Jan 1995 | A |
5443484 | Kirsch et al. | Aug 1995 | A |
5448990 | De Faria-Correa | Sep 1995 | A |
5538497 | Hori | Jul 1996 | A |
5569160 | Sauer et al. | Oct 1996 | A |
5588949 | Taylor et al. | Dec 1996 | A |
5653677 | Okada et al. | Aug 1997 | A |
5720761 | Kaali | Feb 1998 | A |
5791231 | Cohn et al. | Aug 1998 | A |
5797943 | Danks et al. | Aug 1998 | A |
5860996 | Urban et al. | Jan 1999 | A |
5891013 | Thompson | Apr 1999 | A |
5899851 | Koninckx | May 1999 | A |
5957832 | Taylor et al. | Sep 1999 | A |
6097423 | Mattsson-Boze et al. | Aug 2000 | A |
6348034 | Thompson | Feb 2002 | B1 |
6371909 | Hoeg et al. | Apr 2002 | B1 |
6387043 | Yoon | May 2002 | B1 |
6478730 | Bala et al. | Nov 2002 | B1 |
6508759 | Taylor et al. | Jan 2003 | B1 |
6527704 | Chang et al. | Mar 2003 | B1 |
6648816 | Irion et al. | Nov 2003 | B2 |
6767321 | Czarnek et al. | Jul 2004 | B2 |
6863651 | Remijan et al. | Mar 2005 | B2 |
6916286 | Kazakevich | Jul 2005 | B2 |
6984203 | Tartaglia et al. | Jan 2006 | B2 |
6986738 | Glukhovsky et al. | Jan 2006 | B2 |
7037258 | Chatenever et al. | May 2006 | B2 |
7041052 | Saadat et al. | May 2006 | B2 |
7066879 | Fowler et al. | Jun 2006 | B2 |
7322934 | Miyake et al. | Jan 2008 | B2 |
7585273 | Adler et al. | Sep 2009 | B2 |
7604648 | Kerr | Oct 2009 | B2 |
7927272 | Bayer et al. | Apr 2011 | B2 |
8083667 | Cooper et al. | Dec 2011 | B2 |
8105233 | Abou El Kheir | Jan 2012 | B2 |
20020049367 | Irion et al. | Apr 2002 | A1 |
20030055319 | Chang | Mar 2003 | A1 |
20030236505 | Bonadio et al. | Dec 2003 | A1 |
20050029978 | Oleynikov et al. | Feb 2005 | A1 |
20050059862 | Phan | Mar 2005 | A1 |
20050085691 | Nakao | Apr 2005 | A1 |
20050154256 | Breidenthal et al. | Jul 2005 | A1 |
20050182293 | Katzman | Aug 2005 | A1 |
20050234296 | Saadat et al. | Oct 2005 | A1 |
20060069314 | Farr | Mar 2006 | A1 |
20060106286 | Wendlandt et al. | May 2006 | A1 |
20060183095 | Korndorffer et al. | Aug 2006 | A1 |
20060252994 | Ratnakar | Nov 2006 | A1 |
20070032701 | Fowler et al. | Feb 2007 | A1 |
20070073109 | Irion | Mar 2007 | A1 |
20070093812 | Hayashida et al. | Apr 2007 | A1 |
20070179430 | Smith et al. | Aug 2007 | A1 |
20070249899 | Seifert | Oct 2007 | A1 |
20080027279 | Abou El Kheir | Jan 2008 | A1 |
20080065099 | Cooper et al. | Mar 2008 | A1 |
20080147018 | Squilla et al. | Jun 2008 | A1 |
20080208006 | Farr | Aug 2008 | A1 |
20080269557 | Marescaux et al. | Oct 2008 | A1 |
20080269562 | Marescaux et al. | Oct 2008 | A1 |
20090012530 | Fowler | Jan 2009 | A1 |
20090018400 | Raymond et al. | Jan 2009 | A1 |
20090036744 | Vayser | Feb 2009 | A1 |
20090259097 | Thompson | Oct 2009 | A1 |
20090259102 | Koninckx et al. | Oct 2009 | A1 |
20090275799 | Saadat et al. | Nov 2009 | A1 |
20090312773 | Cabrera et al. | Dec 2009 | A1 |
20100010504 | Simaan et al. | Jan 2010 | A1 |
20100081875 | Fowler et al. | Apr 2010 | A1 |
20100185197 | Sakao et al. | Jul 2010 | A1 |
20100280316 | Dietz et al. | Nov 2010 | A1 |
Number | Date | Country |
---|---|---|
0556056 | Aug 1993 | EP |
Entry |
---|
Cadeddu, J. et al., “Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience,” Surg. Endoc. (2009) 23: 1894-1899. |
Fowler, D.L. et al., “Initial trial of a stereoscopic, insertable, remotely controlled camera for minimal access surgery,” Surg. Endosc. (2010) 24:9-15. |
International Search Report and Written Opinion for International Application No. PCT/US2010/028881 mailed on Oct. 29, 2010. |
http://www.karlstorz-hd-endoscopy.com, 1 page. (accessed Jan. 27, 2011.). |
Number | Date | Country | |
---|---|---|---|
20100249512 A1 | Sep 2010 | US |
Number | Date | Country | |
---|---|---|---|
61164215 | Mar 2009 | US | |
61261910 | Nov 2009 | US |