This document relates generally to medical devices, and more particularly, to systems, devices and methods for sealing an opening in a body during a surgical procedure.
Certain surgical procedures, such as minimally-invasive or laparoscopic surgery, can involve delivery of an insufflation of a gas into the body. For example, in a laparoscopic procedure, an insufflation gas can be delivered to the peritoneal cavity of a patient to distend the abdomen and improve visual and physical access to internal organs in the abdomen. Distension of the patient's abdomen can provide sufficient operating space enable adequate visualization of the structures and manipulation of instruments inside a patient.
It is important to maintain a sealed system to maintain insufflation during a surgical procedure. For example, the interface between surgical equipment and an access orifice in the patient's body must be sealed to avoid or reduce leakage of insufflation gas so that insufflation can be maintained.
In a less-invasive surgical procedure, such as a laparoscopic procedure, one or more cannulas are typically used to a deliver surgical tools into a body cavity. A cannula seal can be used to provide a seal between the cannula an outer surface of an instrument shaft that is connected to surgical tool to avoid or reduce leakage of insufflation gas through the cannula during the procedure. The cannula seal is a critical component for surgery in the abdomen, because without it there is no insufflation, and without insufflation surgery cannot be effectively carried out.
An example seal for sealing against a surgical instrument shaft can include a first seal layer having a first seal opening and a second seal layer having a second seal opening. The second seal opening can overlap with the first seal opening. An effective seal opening can be defined at least in part by the first seal layer and the second seal layer at a region where the first seal opening overlaps with the second seal opening. The effective seal opening can be smaller than the first seal opening and the second seal opening. The effective seal opening can be sized and shaped to seal against an instrument shaft when an instrument shaft is inserted through the effective seal opening.
In some examples, when an instrument shaft that is larger than the effective seal opening is inserted through the effective seal opening, the first seal opening or the second seal opening deforms to accommodate the instrument shaft.
In some examples, the first seal opening has a first center, and the second seal opening has a second center, and the second center is offset from the first center.
In some examples, the seal includes a third seal layer that has a third seal opening, and the third seal opening has a third center that is offset from the first center and the second center. In some examples, the seal also includes a fourth seal layer having a fourth seal opening, and the fourth seal opening has a fourth center that is offset from the first center, the second center, and the third center.
In some examples, the first seal opening and the second seal opening both have a circular shape.
In some examples, the first seal opening has an elliptical, ovular, or oblong shape.
In some examples, the first seal opening is a different size or different shape than the second seal opening.
In some examples, the first seal layer has a first thickness, and moving the instrument shaft off the axis a first distance creates less distortion in the effective opening than would occur in a comparable single-layer seal formed of a single layer having a comparable thickness that is equal to the first thickness and a comparable opening that is the same size and the effective opening.
In some examples, the seal includes a first seal component that includes a first end wall that includes the first seal layer and the first seal opening, and a first side wall connected to the first end wall, the first side wall extending around and defining a first interior chamber, and a second seal component that includes a second end wall that includes the second seal layer and the second seal opening, and a second side wall connected to the second end wall, the second side wall extending around and defining a second interior chamber, the second seal component sized and shaped to fit inside the first interior chamber of the first seal component. In some examples, the seal further includes a third seal component that includes a third end wall and a third side wall connected to the third end wall, the third side wall extending around a third interior chamber, the third seal component sized and shaped to fit inside the second interior chamber of the second seal component, the third end wall including a third seal layer and a third seal opening. In some examples, the seal further includes a fourth seal component that includes a fourth end wall and a fourth side wall connected to the fourth end wall, the fourth side wall extending around a fourth interior chamber, the fourth seal component sized and shaped to fit inside the third interior chamber of the third seal component, the fourth end wall including a fourth seal layer and a fourth seal opening in the fourth seal layer, the first seal layer, the second seal layer, the third seal layer, and the fourth seal layer defining the effective seal opening at a region where the first seal opening, the second seal opening, the third seal opening, and the fourth seal opening overlap.
An example multi-layer instrument seal can include a first seal component having a first seal wall and a first opening in the first seal wall, and a first side wall connected to and extending around the first seal wall, the first side wall defining a first interior chamber, and a second seal component having a second seal wall and a second opening in the second seal wall, and a second side wall connected to and extending around the second seal wall, the second side wall defining a second interior chamber, the second seal component can be sized and shaped to fit inside the first interior chamber of the first seal component, and a third seal component having a third seal wall and a third opening in the third seal wall, and a third side wall connected to and extending around the third seal wall, the third side wall defining a third interior chamber, the third seal component can be sized and shaped to fit inside the second interior chamber of the second seal component. The first opening, the second opening, and third opening can overlap with each other. An effective opening can be defined inside a region that intersects with the first opening, the second opening, and the third opening. The multi-layer instrument seal can be sized and shaped to seal against an instrument shaft when the instrument shaft extends through first opening, the second opening, and the third opening.
In some example, the multi-layer instrument seal can further include a fourth seal component having a fourth seal wall and a fourth opening in the fourth seal wall, and a fourth side wall connected to and extending around the fourth seal wall, the fourth side wall defining a fourth interior chamber, the fourth seal component can be sized and shaped to fit inside the third interior chamber of the third seal component. The effective opening can be defined by a region that intersects with the first opening, the second opening, the third opening, and the fourth opening. In some examples, the first opening, the second opening, and the third opening are equally spaced from each other. In some examples, the first opening, the second opening, and the third opening are the same size.
In some examples, an instrument shaft that has a cross-section that is larger than the effective opening can be inserted through the effective opening, and the seal applies normal forces against the instrument shaft that are smaller than the forces that would be created if the seal was a single layer of thickness and had an opening that is coextensive with the effective opening.
In some examples, the multi-layer instrument seal has a proximal opening. The proximal opening and the effective opening can define an axis extending from the proximal opening to the effective opening. The instrument shaft can be insertable through the proximal opening and the effective opening along the axis. In a first state the instrument shaft is in a first position aligned with the axis. In a second state the instrument shaft can be at a second position offset from the axis, in the second state one or more of the first seal wall, the second seal wall, and the third seal wall are stretched to deform one or more of the first opening, the second opening, or the third opening. In some examples, by portions of first seal component, second seal component, and third seal component that define the effective opening seal against the instrument shaft in both the first state and the second state.
In some examples, in a third state the instrument shaft is offset from the axis to a third position that is different from the second position, and when instrument shaft is moved from the second position to the third position, one or more of the first seal wall, the second seal wall, and the third seal wall are stretched, and one or more of the first seal wall, the second seal wall, and the third seal wall are relaxed, so that the by portions of first seal component, second seal component, and third seal component that define the effective opening seal against the instrument shaft in the third state.
An example method can include receiving an instrument shaft along an axis through an effective opening in a multi-layer seal that seals against the instrument shaft, at least a portion of the effective opening formed by a first seal layer having a first opening and a second seal layer having a second opening, the second opening overlapping and not coextensive with the first opening. When the instrument shaft is moved to a first position off the axis, one or more of the first seal layer and the second seal layer can be stretched to move the effective opening toward the first position of the instrument shaft in some examples, when the instrument shaft is moved from the first position to a second position off the axis, the first seal layer can be relaxed and the second seal layer can be stretched to adjust the position of the effective opening to match the second position of the instrument shaft.
In some examples, the first seal layer has a first thickness, and moving the instrument shaft off the axis a first distance creates less distortion in the effective opening than would occur in a comparable single-layer seal formed of a single layer having a comparable thickness that is equal to the first thickness and a comparable opening that is the same size and the effective opening.
Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.
This Summary is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application.
In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.
In some surgeries, it is desirable to exchange tools during the surgical procedure. For example, different visualization tools or surgical tools can be required at different points during a procedure, or based upon events or discoveries during the procedure. Exchanging a tool during a procedure can present a problem, however, as seals are frequently designed to accommodate a particular shaft size. A mismatch between tool size and seal size can create procedural problems, such as damage to the seal or insufflation gas leaks. Temporary loss of pressure during certain portions of the procedure is not catastrophic, as more insufflation gas can be delivered to reestablish insufflation, but preservation of insufflation is generally needed during the manipulation of tools as the procedure is carried out.
When a tool change is needed, an entire cannula seal can be exchanged, but switching out a cannula seal to accommodate a tool change during a procedure can be time consuming and inconvenient.
To avoid the need to change the cannula or cannula seal during a procedure, a seal component can be configured to accommodate a range of instrument shaft sizes. A seal that allows for the exchange of surgical instruments, without changing the seal itself, can avoid procedural difficulties and time-consuming extra steps during the procedure. A cannula seal with an expandable seal opening can accommodate a range of instrument shaft sizes and enable a tool exchange during a procedure without exchanging the cannula seal. However, in an expandable seal that depends on stretching of material to accommodate a shaft that is larger than a neutral size of a seal opening, friction can become a problem, especially when an instrument is significantly larger than the opening. When an instrument that is larger than a seal opening is inserted through the opening, normal forces between the seal wall and the instrument shaft can generate significant frictional forces, due to the resistance by the seal material to the stretching required to accommodate the instrument shaft. The friction forces can in some instances make it excessively difficult to move an instrument shaft or detect forces present at an instrument-tissue interface at the surgical site. Forces can also be a problem when a user is attempting to move an instrument shaft away from a neutral axis. When an instrument shaft that is moved away from a neutral axis, the seal tends to resist the off-axis movement and bias the instrument back toward the neutral axis. The friction forces created by the seal-instrument interface can also complicate the use of a force-sensitive control system. Some tele-robotically-assisted surgical systems, such as the Intuit Surgical da Vinci surgical system, can use force sensors to detect and communicate forces in the system. This force-sensitive capability can be particularly useful, for example, to convey to a user (e.g., a surgeon) the amount of force that is experienced between a surgical tool and tissue at the surgical site. Excessive frictional forces between a seal and an instrument shaft can make it more difficult to ascertain or communicate the forces present at the surgical tool.
Another problem that can arise with a stretchable seal opening is the development of a gap between the seal and an instrument shaft when the instrument shaft is moved off-axis, i.e. laterally toward a side wall of the cannula. For example, a circular opening that is stretched to accommodate lateral movement of an instrument shaft can distort into a “cat-eye” shape, which can produce one or more gaps through which insufflation gas can escape.
To accommodate a range of instrument shaft sizes while avoiding leakage, avoiding the development of undesired frictional or other forces between a seal and an instrument shaft, and preferably avoiding both leakage and undesired forces, a seal can be formed from a plurality of seal wall layers that have overlapping openings. The seal openings can be arranged so that they overlap, but do not coincide. In this arrangement, where seal openings overlap but do not coincide, a portion of one or more of the openings is covered or blocked by one or more layers. A region where the openings overlap but are not blocked by any layer can be considered an “effective opening” or “effective seal opening”.
An instrument shaft can be inserted through the effective opening to access a surgical site. To avoid or reduce leakage, it can be desirable to form an effective opening that has a size and shape that is slightly smaller than a minimum instrument shaft cross section. When an instrument shaft that is larger than that effective opening, or has a different shape than the effective opening, is inserted through the opening, one or more of the layers will be forced to move to accommodate the instrument shaft. When the actual opening in a particular layer is larger than the instrument shaft, that particular layer can accommodate the shaft by distorting the shape of the opening, e.g. distort a circle into an oblong shape, or bias a side of an ellipse outward away from the major or minor axis, or both axes. Changing the shape of an opening can require less stretching of seal material—and thus less force—than enlarging an opening that is smaller than the instrument shaft. By stacking a plurality of layers that each have relatively large openings, one can form an effective opening of a desired size that is smaller than the size of some or all of the individual openings, and allow the effective opening to be enlarged by an instrument shaft by deforming the shape of the individual openings in the seal layers. This form of expansion of the effective opening can reduce or avoid stretching of the seal material to accommodate an instrument shaft that is larger than the effective opening, and can thus reduce normal and frictional forces on the instrument shaft.
A multi-layer seal with overlapping openings that create an effective seal opening can also provide desirable performance characteristics when an instrument shaft is moved off-axis, e.g., away from an axis that can be perpendicular to the seal and extends through the effective opening. When the instrument shaft is biased away from the axis, one or more of the openings in the layers can be deformed to accommodate the movement. As the instrument is moved around relative to the axis, some of the seal layers can deform to accommodate the movement, while other relax toward a neutral state. In some examples, the effective opening can be thought of a “floating hole”, because the size and shape of the opening can be approximately constant while the center of the effective opening moves relative to the axis, due to the simultaneous deformation and relaxing (i.e. returning toward a neutral state) of the layers that form the openings. The movement of the seal layers that form the effective opening can reduce or eliminate distortion of the effective seal opening, which can avoid or reduce leakage of insufflation gas when the instrument shaft is moved off axis. For example, in some configurations, a “cat-eye” problem where deformation of a seal by off-axis movement of an instrument shaft creates a pathway for escape of insufflation gas—can be avoided by the simultaneous movement of the seal layers.
The effective opening can, for example, be a circle, or approximate a circle, to match the most common instrument shaft form factor—a cylinder. In an example, a plurality of layers can each have a circular opening, and the circular openings can overlap, but be offset from one another, i.e. non-concentric. The overlapping circular openings can be equally spaced to form a shape formed from a number of arcs of circles. Such a shape formed from arcs of circles can roughly approximate a circle, and can be distorted into a circle by an instrument shaft.
In an example, a plurality of circular openings each have a diameter that is at least twice the diameter of the minimum shaft diameter for which the seal is designed, i.e. at least twice the diameter of the smallest circle that can be drawn around the outside of the effective opening without intersecting the opening, to avoid leaving a gap between the instrument shaft and the seal, through which insufflation gas could escape. In some examples, each of the circular openings have a diameter that is at least three times the minimum shaft diameter. In some examples, each of the openings can have a diameter that is at least as large as the maximum instrument shaft for which the instrument is designed. In some examples, a portion of each opening is a circular or other type of arc, and the remainder of the opening is oblong or irregular.
In other examples, other non-circular shaped openings can be used to form a desired effective opening profile. For example, layers can be formed with oval or ellipse shaped opening. Ovular or elliptical openings can be advantageous because the ovular or elliptical shape can deform more, and stretch less, resulting in lower forces on the instrument shaft. Shapes can also be formed using parabola or hyperbola geometries that, as described above, allow an opening in a layer to deform to reduce or avoid stretching the seal material.
Other opening shapes are possible, and can be distorted to accommodate an instrument as described above. For example, an opening in a layer can be a rectangle, pentagon, octagon or other polygon, or an irregular angular or curved shape, which can include an arc of a circle, ellipse, parabola, or hyperbola.
The openings can all be the same size and shape, or can vary in size, vary shape, or both size and shape. In some examples, the layers include openings that are different sizes of the same shape, e.g. different sized circles, ellipses, or ovals. In some examples, the openings are not evenly spaced on the seal wall. Varying the size, shape, and configuration of the openings can allow for design of a seal with a desired performance or preferential direction or range of movement. For example, the openings can be designed to more easily accommodate movement along a selected axis, or in a particular direction or directions.
In some examples, an effective opening profile can be a Reuleaux polygon—a shape formed from a number of arcs of circles each having a center that is on one of the other arcs. For example, a three-layer seal component can be configured with openings that form an effective opening that has a Reuleaux triangle profile. Such a shape can be formed by three layers having circular openings. In another example, a four-layer seal component can be configured with openings that form a four-sided Reuleaux polygon. Such a shape can be formed by four layers each having a circular opening. Five-sided and six-sided Reuleaux polygons are also possible. Effective openings with a Reuleaux polygon profile can also be formed using layers that have openings that have circular arc features but do not form full circles.
A multi-layer seal can be provided as a seal assembly, for example by stacking or nesting a number of seal components that each have a seal opening. Other configurations are also possible. For example, layers can be situated on top of each other and secured in a desired configuration using mechanical techniques, such as clamping or other types of compressing layers together, sewing, mechanical bonding, locking features such as key, or a combination thereof. Layers can also be secured together using other techniques, such as chemical bonding (e.g., application of adhesive), along or in combination with mechanical techniques. In some examples, nesting sealing components can be provided with matching inner and outer tapers, which allows the components to fit together with little or no gaps between the components.
An expanding multi-layer seal assembly can be used with a surgical system that includes tools that allow a physician to see and manipulate tissue (or other objects or materials) inside a patient's body, using controls situated outside the patient's body. Visualization tools can, for example, include optical tools, such as fiber optic cameras, or electronic tools, such as digital cameras or sensors. Surgical tools can include, for example mechanical or electromechanical tools such as needle drivers, suture tools, retraction instruments, clip appliers, probes, fenestrated graspers, or cardiac stabilizers. Surgical tools can also include energy instruments such as monopolar or bipolar tools, ultrasonic tools, or lasers, which can be used for cautery or ablation, for example. Tools can be coupled to a computer system and electromechanical manipulators to provide precision and ease of use for a physician or clinical personnel. The use of such systems is sometimes referred to as a robot-assisted minimally invasive surgery.
Referring again to
An instrument shaft can be inserted through the effective opening 305. The layers 330, 335, 340, 345 will deform to change the shape of the openings 331, 336, 341, 346 to accommodate the instrument shaft. In an example, the layers can be formed by assembling nesting components, as previously described, and as shown in
In an example, the seal component 300 can be formed of polyisoprene, which can provide good flexibility and tear resistance. In other examples, the seal component 300 can be formed of silicone or other rubber materials.
In the example shown in
While the openings are illustrated as circles, the openings in the seal layers can be selected from a variety of possible shapes, such as ellipses, ovals, oblong shapes, Reuleaux polygons, or other shapes.
A seal component that has multiple seal layers can be constructed as an assembly of seal components that each have a seal opening.
As shown in
In an example, a seal has a plurality of layers that each has a circular opening having a diameter of at least 8 millimeters, and the layers overlap to form an effective opening of 3.8 mm to 4.4 mm (preferably 4.1 mm), to accommodate a range of instrument shaft sizes from 5 to 8 millimeters.
In the various configurations shown in
In the various configurations shown in
In the various configurations shown in
A seal component can also be designed to accommodate an instrument shaft that is not round (i.e. a non-cylindrical shaft). Some camera shafts, for example, have an oblong cross section. Openings in seal layers can be configured to define an oblong effective opening. In some examples, such an opening could work with larger circular shafts (large enough to fill the effective opening). In an example, an elliptical effective opening can be designed with a major axis that is similar in size to a cylindrical shaft, and a minor axis that is similar in size to a cross-dimension of an oblong shaft or a minor axis of an elliptical shaft.
Any of the example components described herein can be formed of a material that provides good flexibility and tear resistance, such as polyisoprene. Components can also be formed of silicone or other rubber materials.
Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.
The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.
In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
Geometric terms, such as “parallel”, “perpendicular”, “round”, or “square”, are not intended to require absolute mathematical precision, unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as “round” or “generally round”, a component that is not precisely circular (e.g., one that is slightly oblong or is a many-sided polygon) is still encompassed by this description.
Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.
The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
This application claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/413,818, filed on Oct. 27, 2016, which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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62413818 | Oct 2016 | US |